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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 [1]
- 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)
General
focal segmental glomerulosclerosis (FSGS)
References
- Schaefer L, Paik JM, Rennke H, Levy BD, Loscalzo J.
Itching for a Diagnosis
N Engl J Med 2015; 372:964-968. March 5, 2015
PMID: 25738673
http://www.nejm.org/doi/full/10.1056/NEJMcps1409348