title: Collapsing glomerulopathy is common in the setting of thrombotic microangiopathy of the native kidney.
abstract: Thrombotic microangiopathy (TMA) is a poorly recognized cause of collapsing glomerulopathy. The frequency and significance of collapsing glomerulopathy associated with renal TMA have not been specifically studied in native kidney biopsy specimens. Here we retrospectively documented clinicopathologic features of 53 patients with histologically proven TMA in the native kidney, with special emphasis on changes due to focal segmental glomerulosclerosis (FSGS). Histological TMA was related to hypertensive nephropathy in 21 patients, genetic complement abnormalities in 9, drugs in 7, and to other causes in 16 patients. Almost half (26 patients) presented with arteriolar, 6 with glomerular, and 21 with mixed TMA. Using the Columbia classification system for the 53 patients with histological TMA, 33 had concurrent FSGS lesions with collapsing glomerulopathy the dominant variant in 19 patients (58% of the FSGS cases), not otherwise specified in 9 patients, cellular in 3, and perihilar or tip lesions in 1 patient each. The presence of FSGS was associated with a poor renal prognosis, with no prognostic difference between collapsing glomerulopathy and other FSGS variants. Thus, collapsing glomerulopathy is frequently found in native kidney biopsies with TMA, suggesting that endothelial injury may play an important role in the pathophysiology of FSGS.
authors.affiliation: Pathology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Paris, France; INSERM, UMR S 1155, Paris, France. Electronic address: david.buob@aphp.fr.
authors.forename: David
authors.initials: D
authors.lastname: Buob
authors.affiliation: Nephrology Department, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; University Lille Nord de France, Lille, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Decambron
authors.affiliation: University Lille Nord de France, Lille, France; Pathology Department, Centre de Biologie Pathologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: Viviane
authors.initials: V
authors.lastname: Gnemmi
authors.affiliation: Nephrology Department, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; University Lille Nord de France, Lille, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Frimat
authors.affiliation: Nephrology Department, Hôpital Privé de La Louvière, Lille, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Hoffmann
authors.affiliation: Nephrology Department, Centre Hospitalier de Dunkerque, Dunkerque, France.
authors.forename: Raymond
authors.initials: R
authors.lastname: Azar
authors.affiliation: Nephrology Department, Hôpital Privé de Bois Bernard, Rouvroy, France.
authors.forename: Jean-Dominique
authors.initials: JD
authors.lastname: Gheerbrant
authors.affiliation: Nephrology Department, Centre Hospitalier de Roubaix, Roubaix, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Guincestre
authors.affiliation: Nephrology Department, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; University Lille Nord de France, Lille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Noël
authors.affiliation: University Lille Nord de France, Lille, France; Pathology Department, Centre de Biologie Pathologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Copin
authors.affiliation: Nephrology Department, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; University Lille Nord de France, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Glowacki
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D057049:Thrombotic Microangiopathies / Q000150:complications*; D055815:Young Adult
keywords: FSGS; collapsing glomerulopathy; thrombotic microangiopathy