A case report on primary collapsing glomerulopathy in a Filipino post-partum female and an updated review of literature
https://doi.org/10.47895/amp.vi0.6457
- Author:
Kristine May F. Valmoria
1
;
Raymond S. Alonso
1
Author Information
1. Division of Nephrology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
- Publication Type:Journal Article
- Keywords:
Glomerulosclerosis
- MeSH:
Nephrotic Syndrome;
Immunosuppression Therapy
- From:
Acta Medica Philippina
2024;58(2):98-106
- CountryPhilippines
- Language:English
-
Abstract:
Collapsing Glomerulopathy (CG) is a rare entity presenting as nephrotic syndrome and rapidly progressive renal
deterioration. It has been first identified among African-American patients and subsequently dubbed HIV-associated nephropathy after a number of patients with HIV were found to have CG. It has re-emerged recently among patients with COVID-19. To our knowledge, this is the first case of primary collapsing glomerulopathy in the country to be published.
The case is a 36-year-old Filipino female admitted due to bipedal edema which started 2 weeks post-partum. She
has no comorbidities and social history was negative for illicit drug use. Initial work up showed hypoalbuminemia and diffuse hepatic disease on ultrasound. She was referred to a gastroenterologist where albumin infusion and paracentesis was done but with no improvement. She developed anasarca and was admitted. Paracentesis obtained minimal ascitic fluid. Serum ascites albumin gradient was low and baseline laboratories showed high creatinine, hypoalbuminemia, and albuminuria. 24-hour urine protein was 11 grams, ANA and anti-DsDNA were negative and c3 and c4 levels were normal. Hepatitis profile was negative for infection. Abdominal CT scan revealed multiple hypoenhancing lesions. Tumor markers CA-125, CA 19-9 and CA 15-3 were high. Breast ultrasound showed simple breast cyst. Gynecology consult was called where pap smear was negative for atypical cells. Surgery service recommended monitoring for the pancreatic and breast lesions. Kidney biopsy was delayed due to new onset bacterial pneumonia. COVID-19 RT-PCR test was negative. Patient was discharged improved with no edema. On follow up, the kidney biopsy result came out to be collapsing glomerulopathy. HIV test was then done and was negative. Bipedal edema and albuminuria recurred. She was started on tacrolimus. She has been on regular follow up and currently has no edema, no proteinuria and normal creatinine level.
This is an interesting case as the primary glomerular disease has been masked by the earlier laboratory findings
which led us to think of liver disease then a paraneoplastic nephrotic syndrome. Ultimately, the renal biopsy revealed the diagnosis. This serves as an index case for primary collapsing glomerulopathy in a Filipino patient on remission after being treated with tacrolimus.
- Full text:6457-Article Text-96817-2-10-20240208.pdf
