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Lupus podocytopathy (LP) is characterized by diffuse epithelial cell foot process effacement with only mesangial immune complex deposits or no deposits. The most common presentation is nephrotic syndrome. The paradigm has changed from being considered the coexistence of two distinct pathologies and it is now considered part of the systemic lupus erythematosus spectrum.
The reported prevalence in biospies of patients with SLE is of 1% and it can be divided into two subclasses: minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS), both of which can have mesangial proliferation. It is common for the kidney to be one of the first organs affected in SLE with the presence of acute kidney injury (AKI) associated with tubular damage.
Primary outcome: Evaluate the clinical behavior and outcome of renal function of collapsing LP when compared with collapsing podocytopathy due to other etiologies.
Retrospective case-control study at the National Institute of Cardiology between 2010 and 2023.
A total of 15 patients were analyzed. Collapsing LP more commonly presented as severe AKI requiring renal replacement therapy (RRT) (75%) and had a lower degree of proteinuria compared to patients with a collapsing podocytopathy due to other etiologies, presenting with massiv eproteinuira (p=0.004). In the LP group, a better repsosne to treatment was observed with improvement in kidney function and all of the patients no longer required RRT in the 100 month follow up, whilst also having a lower risk of developing chronic kidney disease. Analizing histological differenced, the LP group had more mesangial proliferation.
Collapsing lupus podocytopathy is a rare renal manifestation of SLE, having a more severe presentation, but having a higher response rate to treatment and better renal prognosis compared to collapsing FSGS due to other etiologies.