Collapsing glomerulopathy in renal allografts: A morphological pattern with diverse clinicopathologic associations

We reviewed the clinical and pathological characteristics of seven patients with collapsing glomerulopathy (CG) in renal allograft biopsy specimens, A ll patients underwent biopsies for graft dysfunction. Two patients had neph rotic proteinuria (protein, >3.5 g/24 h), whereas all others had only modes t or insignificant proteinuria, In five of seven patients, additional patho logical processes, including microvascular injury, acute rejection, recurre nt diabetic nephropathy, and immune complex glomerulonephritis, were presen t, each of which likely contributed to graft dysfunction and proteinuria, N one of the patients in this series had nephrotic syndrome solely attributab le to CG. Three biopsy specimens had features consistent with chronic rejec tion. The development of CG in renal allograft biopsy specimens was associa ted with graft dysfunction and a high rate of graft loss. These findings em phasize the prognostic significance of CG in renal allografts and suggest t hat CG may result from diverse pathogenic mechanisms. (C) 1999 by the Natio nal Kidney Foundation, Inc.