title: Collapsing glomerulopathy in 19 patients with systemic lupus erythematosus or lupus-like disease.
abstract: OBJECTIVE
  Collapsing glomerulopathy is a podocytopathy with segmental or global wrinkling and collapse of capillary walls and overlying epithelial cell proliferation. Idiopathic collapsing glomerulopathy is a distinct clinicopathologic entity with significant proteinuria, poor response to immunosuppressive therapy, and rapid progression to renal failure. Collapsing glomerulopathy is associated with viral infections, autoimmune disease, and drugs. This work presents the largest group of collapsing glomerulopathy in patients with SLE.
  
  
  METHODS
  Clinicopathological features were retrospectively studied in 19 patients with SLE (16 patients) or SLE-like (3 patients) disease with collapsing glomerulopathy.
  
  
  RESULTS
  Initially, 95% of patients had nephrotic syndrome with proteinuria of 3-12 g per 24 hours, creatinine levels of 0.6-9.6 mg/dl, positive lupus serologies, and normal complement levels in 63%. Segmental and/or global collapsing glomerulopathy was seen in 11%-77% of glomeruli. Tubular atrophy with focal microcystic changes and interstitial fibrosis was seen in 35% of patients. Minimal glomerular mesangial deposits were noted in 63% of patients, and extensive foot process effacement was seen in 82% of patients. Initial treatment was with pulse/oral steroids. Follow-up from 13 patients revealed that 7 patients progressed to ESRD at the time of biopsy up to 21 months later, 1 patient returned to normal creatinine (1.1 mg/dl) without proteinuria, and 5 patients had creatinine of 1.2-3.6 mg/dl with proteinuria of 0.37-4 g per 24 hours.
  
  
  CONCLUSIONS
  Collapsing glomerulopathy may be seen in SLE patients presenting with massive proteinuria with or without lupus nephritis, which may have prognostic significance.
authors.affiliation: Department of Pathology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Salvatore
authors.forename: Laura M C
authors.initials: LM
authors.lastname: Barisoni
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Herzenberg
authors.forename: Praveen N
authors.initials: PN
authors.lastname: Chander
authors.forename: Volker
authors.initials: V
authors.lastname: Nickeleit
authors.forename: Surya V
authors.initials: SV
authors.lastname: Seshan
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006801:Humans; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology; D007678:Kidney Glomerulus / Q000187:drug effects / Q000473:pathology*; D007684:Kidney Tubules / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008181:Lupus Nephritis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology / Q000473:pathology; D011507:Proteinuria / Q000209:etiology / Q000473:pathology; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids