Ana Carina Ferreira

Collapsing glomerulopathy in Portugal: a review of the histological and clinical findings in HIV and non-HIV patients

BACKGROUND Collapsing glomerulopathy (CG) is a glomerulonephritis seen in association with human immunodeficiency virus (HIV) infection, known as HIV-associated nephropathy (HIVAN), and less frequently observed in non-HIV-infected patients. Method. The aim of this study was to review the histological and clinical findings of all CG diagnosed since 1981 in our laboratory. Result. Since 1981, 18 kidney biopsies with collapsing features were diagnosed among 6130 biopsies performed: 72.2% (n = 13) males, mean age 33.8 ± 9.7 years, 61.1% (n = 11) of black ethnic origin. HIV infection was present in 10 patients. Mean serum creatinine (Scr) was 4.7 ± 2.5 mg/dL, and mean proteinuria was 6.1 ± 5 g/24 h. Both HIVAN and non-HIVAN patients were similar in terms of age, gender and dialysis requirement. In the HIVAN population, African origin was predominant and more frequent than in the non-HIVAN population, Scr was higher and proteinuria was less severe. Interstitial infiltrate, interstitial fibrosis and tubular atrophy were severe, and the presence of microcystic dilatation of renal tubules was more common. Immunofluorescence was positive in six patients. In the non-HIVAN population, this histological lesion was related to an infectious illness in 6/8 patients and to the use of illegal oral drugs in one patient. Interstitial infiltrate, interstitial fibrosis and tubular atrophy presented as moderate to severe, and tubular atrophy correlated with dialysis requirement. Mesangial proliferation was present in 3/8 patients, with C3 and IgA deposits. CONCLUSION CG is a rare podocytopathy. In this study, the association between infection and CG is evident, and we may suggest that infections could, in a direct or indirect manner, be a trigger of podocyte injury.

Cavernous Sinus Thrombosis in a Patient with Nephrotic Syndrome

Nephrotic syndrome (NS) is a glomerular disease characterized by altered permeability of the glomerular capillary wall to macromolecules. This results in heavy proteinuria, hypoalbuminemia, hypercholesterolemia, lipiduria, and edema. This clinical and laboratory syndrome is a life-threatening disease, and is associated with several complications, not only related to the disease itself, but also related to its treatment. Disease-associated complications include acute kidney injury, chronic kidney disease, cardiovascular disease, negative nitrogen balance, infections, endocrine disorders, and hypercoagulability. Venous and arterial thromboembolism is a significant complication of NS, occurring in approximately 27% of the patients [1]. This represents an 800% increase relatively to the general population [1, 2]. The pathophysiology of thrombogenesis in NS is not fully understood, and seems to be multifactorial [3], depending on the etiology (particularly frequent in membranous nephropathy), serum albumin level (most likely when\2 g/dl), previous episodes, and genetic predisposition [1, 2, 4]. These patients are at an increased risk of deep vein thrombosis (DVP), renal vein thrombosis (RVP), and pulmonary embolism (PE). Cerebral venous thrombosis (CVT) is infrequent, being primarily reported in children [1, 2]. The authors report a case of a 45-year-old white female patient admitted with NS and multiple venous thrombosis.