A case report of three cases in AJKD this month reports de-novo post transplant collapsing glomerulopathy(PTCG). Rare cases of de novo collapsing glomerulopathy have been reported during the post-transplant course and, in some instances, have been associated with renal graft vascular lesions. This finding raises the important question of whether ischemia could induce podocyte transdifferentiation, a hypothesis supported by evidence of hypoxia-inducible factor–dependent podocyte proliferation in HIV-associated nephropathy.This paper nicely shows the immuno-staining of those patients and positive for VEGF at the podocytic injury suggesting that hypoxia induced increased hypoxia inducible factor is leading to increased VEGF for their survival that ultimately leads to the collapse. Other causes that are commonly associated with Collapsing Glomerulapthy are pamidronate use, interferon use, use of sirolimus, parvovirus B19 virus, CMV infection, Renal artery stenosis, SLE, lymphoma, and recently even use of depakote and dilantin. HIV was negative in all patients? It was unclear if parvo virus was checked as post transplant parvo virus B19 cases of collapsing GN has been noted.
It is a devastating disease and something to keep in the differential diagnosis even post transplant in nephrotic range proteinuria. Ischemia likely from chronic rejection, chronic calcineurin use might be the culprits.
The same causes that lead to Collapsing FSGS in the non transplanted kidney, should also be ruled out in the transplanted kidney. The important major difference is the ischemia as a cause might be more evident in transplanted kidney.
An abstract at ASN showed similar findings as well.
- ► 2019 (34)
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- CLINICAL CASE 9
- The Online Transplant Center: Post transplant MPGN...
- Post transplant MPGN
- TOPIC DISCUSSION: PCO2, which one is better?
- Image Quiz- Answers
- CONSULT ROUNDS: METHANOL and the EYE?
- CONSULT ROUNDS: ACID BASE
- JOURNAL CLUB: Kidney allograft nephrectomy can imp...
- TOPIC DISCUSSION: Nutrition
- TOPIC DISCUSSION: Drugs and Cyclosporine
- IN THE NEWS- NSF and Kidney Transplantation
- Bowel Transplantations, not enough!
- Horseshoe Kidney
- The Online Transplant Center: New Agents for renal...
- CLINICAL CASE 8
- History of Nephrology: The first randomised contro...
- Common Sense vs. Evidence-based Medicine
- TOPIC DISCUSSION: DIFFERENT TYPES OF PROTEINURIA
- New Agents for renal transplantation
- TOPIC DISCUSSION: Renal Artery Stenosis
- TOPIC DISCUSSION: THE WWW and the NEPHROLOGIST
- IN THE NEWS- Hyperkalemia treatment in trouble
- IN THE NEWS ---> ACUTE KIDNEY INJURY
- CONSULT ROUNDS: SIADH and Escitalopram ( lexapro)...
- CONSULT ROUNDS: Clinical dilemma in Nephrogenic Di...
- CONSULT ROUNDS: Metformin toxicity, Lactic Acidosi...
- CLINICAL CASE 7
- IN THE NEWS- HgA1C for Diabetes Diagnosis. How abo...
- KIDNEY DONORS have Good Long term survival
- TOPIC DISCUSSION: VEGF Nephropathology
- TOPIC DISCUSSION: Post Transplant Collapsing FSGS,...
- Post Transplant Collapsing FSGS: Is it really all ...
- CLINICAL CASE 6
- Topic Discussion: OUCH!! Should Anesthesia Hurt?...
- TOPIC DISCUSSION: Alcohol Poisonings, gaps and osm...
- Belatacept approved by FDA
- Protocol Biopsies in Renal Allograft Recipients
- ▼ March (37)