COLLAPSING GLOMERULOPATHY-RARE VARIANT OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS-CASE REPORT

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.