Collapsing glomerulopathy occurring in HIV-negative patients with systemic lupus erythematosus: report of three cases and brief review of the literature

Abstract

Collapsing glomerulopathy (CG), once recognized as a distinct renal disease in HIV-positive patients, has since been described in association with a number of other conditions, including autoimmune diseases. Among the latter, CG has been reported in Still’s disease. Extensive search of the literature revealed only three patients with renal biopsy diagnosis of CG in the presence of clinical and serological evidence of SLE (HIV-negative). This case report presents three adult female HIV-negative patients with SLE who were detected as having significant proteinuria and underwent renal biopsy. In all three cases, renal biopsy showed features of diffuse lupus nephritis. In addition, variable numbers of glomeruli showed segmental collapse of glomerular tuft with hyperplasia of overlying visceral epithelial cells and were diagnosed as CG. The patients were managed with aggressive immunosuppressive therapy, including intravenous steroids in two patients and tacrolimus and cyclophosphamide in one patient. All three patients achieved partial remission of proteinuria with maintained renal function at the last follow-up. Collapsing glomerulopathy is a rare occurrence in patients with SLE, which should be considered in patients with lupus nephritis and significant proteinuria. A timely performed renal biopsy allows accurate diagnosis and appropriate therapeutic modifications.