COLLAPSING GLOMERULOPATHY-RARE VARIANT OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS-CASE REPORT
Journal
MMP Македонски медицински преглед = Macedonian medical review
Date Issued
2021
Author(s)
Abstract
Focal segmental glomerulosclerosis (FSGS) is classified
into five variants, with the collapsing variant being
the most rare one. However, the number of idiopathic
cases is increasing and the presentation becoming more
routine.
We report the case of a 77-year-old female patient, with
nephrotic syndrome and histopathologic features of glomerular
capillary collapse. She presented with chronic
renal failure with serum creatinine-126…154…174 μmol/L.
Nephrotic syndrome with feet and ankles edema, progressively
extended, at first failed to respond to diuretic
therapy. The level of total serum protein fraction was
54g/l, albumin-29…24…28g/L. Urinalysis demonstrated
proteinuria 7.8 g/l… 6.15g/L and 12.3 g/24 h. Presence
of 25-30 erythrocytes and 2-3 leukocytes in urine
sediment was also noticed. Renal biopsy was performed
to determinate the presence of glomerular disease.
The histopathological analysis showed fibrously thickened
Bowman’s membrane, with discretely thickened glomerular
basal membrane and collapsed vascular lumen
on TEM analysis. The treatment of the patient included
corticosteroids, angiotensin-converting enzyme inhibitor
and lipid lowering agents, which resulted in lowering
of the proteinuria, followed by withdrawal of the edema.
into five variants, with the collapsing variant being
the most rare one. However, the number of idiopathic
cases is increasing and the presentation becoming more
routine.
We report the case of a 77-year-old female patient, with
nephrotic syndrome and histopathologic features of glomerular
capillary collapse. She presented with chronic
renal failure with serum creatinine-126…154…174 μmol/L.
Nephrotic syndrome with feet and ankles edema, progressively
extended, at first failed to respond to diuretic
therapy. The level of total serum protein fraction was
54g/l, albumin-29…24…28g/L. Urinalysis demonstrated
proteinuria 7.8 g/l… 6.15g/L and 12.3 g/24 h. Presence
of 25-30 erythrocytes and 2-3 leukocytes in urine
sediment was also noticed. Renal biopsy was performed
to determinate the presence of glomerular disease.
The histopathological analysis showed fibrously thickened
Bowman’s membrane, with discretely thickened glomerular
basal membrane and collapsed vascular lumen
on TEM analysis. The treatment of the patient included
corticosteroids, angiotensin-converting enzyme inhibitor
and lipid lowering agents, which resulted in lowering
of the proteinuria, followed by withdrawal of the edema.