De novo collapsing glomerulopathy in renal allografts

Background. Collapsing glomerulopathy is a recently described form of glomerular injury characterized by capillary collapse and visceral epithelial hypercellularity associated with nephrotic range proteinuria and a rapid, progressive decline in renal function. The lesion has rarely been described in allografts, Methods. We reviewed 892 allograft biopsies from a population of 1079 recipients who received renal transplants between 1978 and 1996, Results, Five cases of de novo collapsing glomerulopathy were identified (0.6% of biopsies; 3.2% since 1993), None occurred before 1993, The patients were 31 to 66 years of age and they presented 6 to 25 months after transplantation, The 24-hr urinary protein ranged from 1.8 to 11.8 g, All patients and donors were negative for the human immunodeficiency virus and had no risk factors for human immunodeficiency virus infection. Diffuse or focal, global or segmental collapse of glomerular capillaries, swelling and hypercellularity of the visceral epithelium, hyaline arteriolosclerosis, and interstitial fibrosis were characteristic histologic features. Two cases had concomitant glomerular immune complex deposits. Progressive decline in allograft function occurred within 2-24 months after diagnosis, culminating in return to dialysis in all patients. Conclusion. Collapsing glomerulopathy can arise in renal allografts as a de novo disease. Although its pathogenesis remains to be clarified, it is important to distinguish this lesion in allografts as it can be associated with rapidly progressive graft failure.