Complete remission of non-HIV collapsing glomerulopathy with deflazacort and lisinopril in an adult patient.
Collapsing glomerulopathy is a form of focal segmental glomerulosclerosis that is usually associated with HIV-1 infection, and is characterized by its poor prognosis and almost inevitable progression to end-stage renal disease. Its pathological features include collapsed glomeruli, podocyte hypertrophy and hyperplasia, and pseudocrescents. This case report shows the evolution of a 58-year-old patient with non-HIV idiopathic collapsing glomerulopathy who presented with severe nephrotic syndrome and renal insufficiency and was treated with lisinopril and deflazacort, a synthetic corticosteroid that has shown fewer cosmetic effects and glucose and bone metabolism complications than prednisone. The patient responded with full recovery of renal function and normal range of protein excreted in urine after less than two years of treatment. The patient has not suffered a recurrence of his nephrotic syndrome after three years of steroid withdrawal. There is no proven therapy for collapsing glomerulopathy, and this case highlights an alternative for treating this disease with few secondary effects.
Vega
Jorge
J
Departamento de Nefrología, Diálisis y Trasplante, Hospital Naval A. Nef, Viña del Mar, Chile. jvegastieb@gmail.com
Guarda
Francisco Javier
FJ
Goecke
Helmuth
H
Méndez
Gonzalo P
GP
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001706:Biopsy; D004359:Drug Therapy, Combination; D005921:Glomerulonephritis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D017706:Lisinopril / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology; D011282:Pregnenediones / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000188:drug therapy / Q000209:etiology; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000893:Anti-Inflammatory Agents; D011282:Pregnenediones; D017706:Lisinopril; C021988:deflazacort