Abstract
Collapsing glomerulopathy (CG) is a clinicopathologic entity characterized by segmentar or global collapse of the glomerulus and hypertrophy and hyperplasia of podocytes. The Columbia classification of 2004 classified CG as a histological subtype of focal segmental glomerulosclerosis (FSGS). A growing number of studies have demonstrated a high prevalence of CG in many countries, especially among populations with a higher proportion of people with African descent. The present study is a narrative review of articles extracted from PubMed, Medline, and Scielo databases from September 1, 2020 to December 31, 2021. We have focused on populational studies (specially cross-sectional and cohort articles). CG is defined as a podocytopathy with a distinct pathogenesis characterized by strong podocyte proliferative activity. The most significant risk factors for CG include APOL1 gene mutations and infections with human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2. CG typically presents with more severe symptoms and greater renal damage. The prognosis is notably worse than that of other FSGS subtypes.
Highlights
In many countries, focal segmental glomerulosclerosis (FSGS) comprises the main histological diagnosis in patients with nephrotic syndrome (NS) [1]
Some human immunodeficiency virus (HIV)-associated cases demonstrate 38% delay in the progression to end-stage renal disease (ESRD) following the initiation of antiretroviral therapy (ART) [64]; other studies proposed that up to 50% of patients progress toward the initiation of renal replacement therapy (RRT) despite adequate treatment [65]
The current literature demonstrates that collapsing glomerulopathy (CG) is a distinct clinicopathological entity that results from complex interactions between intrinsic and extrinsic factors
Summary
Focal segmental glomerulosclerosis (FSGS) comprises the main histological diagnosis in patients with nephrotic syndrome (NS) [1]. Eight of 13 CG biopsy samples obtained from the first half of 2016 from a large Brazilian kidney biopsy center were positive for arbovirus, wherein six samples were positive for dengue, one for Zika, and one for a concomitant infection; only one case had APOL1 mutations These findings suggested that direct viral action in tissues may be associated with other risk factors, such as G1 and G2 mutations [42, 43]. Collapsing glomerulopathy can be drug-induced; bisphosphonates, especially pamidronate and zoledronic acid, inhibit the mevalonate synthesis pathways, which are essential for cell differentiation This triggers podocyte proliferation and progression to CG [48]. A significantly high number of patients present with renal failure on admission and rapidly progress to end-stage renal disease (ESRD) [13, 17, 20, 27, 56]
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