In the News: Collapsing Glomerulopathy and SLE

Collapsing FSGS has many causes but its relationship with SLE has been sparse.  Salvatore et al present the largest series of 19 patients with SLE and 3 patients with SLE like disease presenting with Collapsing FSGS.
Findings:
1. Confirmed the proliferative podocyte theory using dedifferentiation and proliferative markers in most biopsy cases.
2. Secondary causes that are more common such as HIV, Parvovirus and medications were ruled out as much as possible in most cases.
3.  Of the 19 patients, 7 had no remission, 5 had partial remission and one had complete remission and some had no follow up
4. Treatment was mainly steroids in most cases and MMF and + dialysis if needed.
5. AA race and female gender predominated.
6. Only 25% progressed to ESRD or death in this group.  This is a surprise as Collapsing FSGS usually has a 99% progression to ESRD.  The authors think this might be because of shorter follow up and or less stringent criteria for the diagnosis of collapsing FSGS.

Check out the article in CJASN