Glomerular collapse associated with subtotal renal infarction in kidney transplant recipients with multiple renal arteries.
Collapsing glomerulopathy is an aggressive kidney disease with rapid progression toward end-stage renal disease. Rare cases of de novo collapsing glomerulopathy have been reported during the post-transplant course and, in some instances, have been associated with renal graft vascular lesions. This finding raises the important question of whether ischemia could induce podocyte transdifferentiation, a hypothesis supported by evidence of hypoxia-inducible factor-dependent podocyte proliferation in HIV-associated nephropathy. We describe here 3 HIV-negative kidney transplant recipients in whom early graft biopsy performed in the vicinity of segmental graft infarction disclosed the typical features of glomerular collapse. Podocyte transdifferentiation was characterized by hallmark lesions, such as loss of mature podocyte phenotype, podocyte proliferation, and acquisition of a macrophage-like phenotype. Together, these data suggest that acute glomerular ischemia may lead to glomerular collapse in kidney transplants.
Canaud
Guillaume
G
Université Paris Descartes, Paris, France. guillaume.canaud@nck.aphp.fr
Bruneval
Patrick
P
Noël
Laure-Hélène
LH
Correas
Jean-Michel
JM
Audard
Vincent
V
Zafrani
Lara
L
Rabant
Marion
M
Timsit
Marc-Olivier
MO
Martinez
Frank
F
Anglicheau
Dany
D
Thervet
Eric
E
Patey
Natacha
N
Legendre
Christophe
C
Zuber
Julien
J
D000328:Adult; D005260:Female; D006801:Humans; D007238:Infarction / Q000209:etiology*; D007668:Kidney / Q000098:blood supply*; D007674:Kidney Diseases / Q000209:etiology* / Q000473:pathology; D007678:Kidney Glomerulus; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D050199:Podocytes