Collapsing Glomerulopathy in Systemic Lupus Erythematosus: An Extreme Form of Lupus Podocytopathy?

[摘要] Collapsing glomerulopathy (CG) describes a pattern of glomerular injury, the main feature of which is severe injury to podocytes with loss of markers of differentiation, proliferation of podocytes and/or parietal epithelial cells filling Bowman’s space, and global or segmental collapse of the capillary tuft (1–4). Multiple etiologies of CG have been described, including certain viral infections (most notably HIV but also parvovirus B19 and hepatitis C), drugs, gene mutations, and vascular occlusion, in addition to idiopathic forms (4–6). In this issue of CJASN, Salvatore et al. (7) report a retrospective series of 19 patients with systemic lupus erythematosus (SLE), none known to be positive for HIV, hepatitis C, or parvovirus, who underwent a renal biopsy for an indication of proteinuria and often renal insufficiency that showed CG, with or without concurrent lupus nephritis. These findings raise important questions regarding the pathogenesis of CG in this clinical setting and the relationship of these lesions to the previously described entity of lupus podocytopathy (8), as well as issues of differential diagnosis on renal biopsy.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome