Collapsing glomerulopathy and thrombotic microangiopathy in postpartum period: Two case reports

• Published in: Indian journal of nephrology Vol. 28; no. 2; pp. 157 - 159
• Main Authors: Gopalakrishnan, N, Dhanapriya, J, Padmakumar, C, Dineshkumar, T, Kurien, A, Sakthirajan, R, Balasubramaniyan, T
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.03.2018; Medknow Publications and Media Pvt. Ltd; Scientific Scholar; Medknow Publications & Media Pvt Ltd
• Subjects: Acute kidney failure; Biopsy; Blood platelets; Care and treatment; Case Report; Case reports; Causes of; Cesarean section; Development and progression; Diagnosis; Disease; Females; Gandhi, Rajiv; Gangrene; Health aspects; Hepatitis; Hospitals; Hyperplasia; Hypertension; Ischemia; Kidneys; Laboratories; Nephrology; Patients; Postpartum period; Preeclampsia; Pregnant women; Risk factors; Sepsis; Urine; Vascular endothelial growth factor; Virus diseases; postpartum; thrombotic microangiopathy; Collapsing glomerulopathy; plasmapheresis
• ISSN: 0971-4065; 1998-3662
• DOI: 10.4103/ijn.IJN_242_16

Collapsing glomerulopathy (CG) is a distinct histopathologic pattern of glomerular injury characterized by global/segmental wrinkling of the glomerular basement membrane with podocyte hyperplasia and hypertrophy along with tubulointerstitial changes. There is no specific treatment for CG due to etiological heterogeneity, and newer insights into the pathogenesis may lead to the development of targeted therapy. The most common form of CG is the primary or idiopathic followed by secondary (due to viral infections, autoimmune disease, drugs, etc.) and genetic causes. Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ failure of variable severity. We here present two young women with preeclampsia who presented with acute kidney injury, anemia, and schistocytes in peripheral smear suggestive of TMA. Renal biopsy showed interesting histopathology of CG in addition to TMA in the first patient and CG alone in the second. Both the patients received supportive therapy while the first patient also received plasmapheresis. One patient had complete recovery, and other had partial recovery of renal function at last follow-up. Combined histopathological lesion of CG with TMA has never been reported in postpartum period so far in literature.