collapsing glomerulopathy; collapsing glomerulonephropathy

Pathology

• acute renal failure

Clinical manifestations

• generalized pruritus (case report)
• no change in urine output

Laboratory

• basic metabolic panel
  • hyponatremia (serum sodium 129 mmol/L case report)
  • uremia (serum urea nitrogen 121 mg/dL case report)
  • serum creatinine 10.6 mg/dL case report
  • hypocalcemia: serum calcium 7.6 mg/dL case report
    • serum albumin 2.4 g/dL, thus ionized calcium normal
• complete blood count (CBC)
  • WBC count 14,000/uL
    • 47% segmented neutrophils, 14% monocytes, 37% lymphocytes, no eosinophils (case report)
• urinalysis consistent with glomerulonephropathy
  • fatty casts
  • no dysmorphic red cells
  • no red-cell casts (thus not glomerulonephritis)
  • urine protein: proteinuria
• 24 hour urine protein for nephrotic syndrome
• fractional excretion of sodium 12% (case report)
• antinuclear antibody to rule out lupus
  • titer positive at 1:160 (case report)
• serum protein electrophoresis & urine electrophoresis to rule out monoclonal gammopathy
• hepatitis B surface antigen in serum, hepatitis C serology, & HIV seroogy to rule out post infectious glomerulonephropathy
• anti-streptolysin O in serum positive (case report)
  • throat culture for group A beta-hemolytic streptococcus positive (case report)
  • however (case report) urinalysis not consistent with poststreptococal glomerulonephritis
• renal biopsy indicated for diagnosis

Radiology

• renal ultrasound
  • enlarged kidneys (12-14 cm case report)
  • increased echogenicity
  • no hydronephrosis

Management

• high-dose glucocorticoid therapy
• hemodialysis as needed for uremia
• prognosis:
  • relapse is not uncommon
  • low level proteinuria may persist (case report)

More general terms

• focal segmental glomerulosclerosis (FSGS)