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Collapsing Glomerulopathy Associated With Natural Killer Cell Leukemia: A Case Report and Review of the Literature

Published:September 12, 2011DOI:https://doi.org/10.1053/j.ajkd.2011.07.011
      We report a case of collapsing glomerulopathy associated with natural killer cell leukemia in a previously healthy 27-year-old African American man. An initial kidney biopsy showed findings concordant with the cellular variant of focal segmental glomerulosclerosis. A repeated biopsy 3 months later showed collapsing glomerulopathy, likely representing a morphologic evolution from a cellular variant into the collapsing glomerulopathy variant of focal segmental glomerulosclerosis. Collapsing glomerulopathy has been described in connection with a number of disparate disorders in which podocyte injury seems to be the common denominator. The close temporal association between clinical presentation and the development of nephropathy provides support for a direct pathogenic link between the underlying lymphoproliferative disorder and the glomerular lesions. We hypothesize that dysregulated cytokine production by the neoplastic cells led to podocyte alterations and eventually to the development of collapsing glomerulopathy.

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      References

        • Greer J.P.
        • Mosse C.A.
        Natural killer-cell neoplasms.
        Curr Hematol Malig Rep. 2009; 4: 245-252
        • D'Agati V.D.
        • Fogo A.B.
        • Bruijn J.A.
        • Jennette J.C.
        Pathologic classification of focal segmental glomerulosclerosis: a working proposal.
        Am J Kidney Dis. 2004; 43: 368-382
        • Liang X.
        • Graham D.K.
        Natural killer cell neoplasms.
        Cancer. 2008; 112: 1425-1436
        • Albaqumi M.
        • Barisoni L.
        Current views on collapsing glomerulopathy.
        J Am Soc Nephrol. 2008; 19: 1276-1281
        • Albaqumi M.
        • Soos T.J.
        • Barisoni L.
        • Nelson P.J.
        Collapsing glomerulopathy.
        J Am Soc Nephrol. 2006; 17: 2854-2863
        • Haas M.
        Collapsing glomerulopathy: many means to a similar end.
        Kidney Int. 2008; 73: 669-671
        • Detwiler R.K.
        • Falk R.J.
        • Hogan S.L.
        • Jennette J.C.
        Collapsing glomerulopathy: a clinically and pathologically distinct variant of focal segmental glomerulosclerosis.
        Kidney Int. 1994; 45: 1416-1424
        • Weiss M.A.
        • Daquioag E.
        • Margolin E.G.
        • Pollak V.E.
        Nephrotic syndrome, progressive irreversible renal failure, and glomerular “collapse”: a new clinicopathologic entity?.
        Am J Kidney Dis. 1986; 7: 20-28
        • Wyatt C.M.
        • Klotman P.E.
        • D'Agati V.D.
        HIV associated-nephropathy: clinical presentation, pathology, and epidemiology in the era of antiretroviral therapy.
        Semin Nephrol. 2008; 28: 513-522
        • Shankland S.J.
        • Eitner F.
        • Hudkins K.L.
        • Goodpaster T.
        • D'Agati V.
        • Alpers C.E.
        Differential expression of cyclin-dependent kinase inhibitors in human glomerular disease: role in podocyte proliferation and maturation.
        Kidney Int. 2000; 58: 674-683
        • Stokes M.B.
        • Valeri A.M.
        • Markowitz G.S.
        • D'Agati V.D.
        Cellular focal segmental glomerulosclerosis: clinical and pathologic features.
        Kidney Int. 2006; 70: 1783-1792
        • Barisoni L.
        • Schnaper H.W.
        • Kopp J.B.
        A proposed taxonomy for the podocytopathies: a reassessment of the primary nephrotic diseases.
        Clin J Am Soc Nephrol. 2007; 2: 529-542
        • van den Berg J.G.
        • Weening J.J.
        Role of the immune system in the pathogenesis of idiopathic nephrotic syndrome.
        Clin Sci (Lond). 2004; 107: 125-136
        • Shalhoub R.J.
        Pathogenesis of lipoid nephrosis: a disorder of T-cell function.
        Lancet. 1974; 2: 556-560
        • Markowitz G.S.
        • Nasr S.H.
        • Stokes M.B.
        • D'Agati V.D.
        Treatment with IFN-α, -β, or -γ is associated with collapsing focal segmental glomerulosclerosis.
        Clin J Am Soc Nephrol. 2010; 5: 607-615
        • Thaunat O.
        • Delahousse M.
        • Fakhouri F.
        • et al.
        Nephrotic syndrome associated with hemophagocytic syndrome.
        Kidney Int. 2006; 69: 1892-1898
        • Karras A.
        What nephrologists need to know about hemophagocytic syndrome.
        Nat Rev Nephrol. 2009; 5: 329-336
        • Mathieson P.W.
        Minimal change nephropathy and focal segmental glomerulosclerosis.
        Semin Immunopathol. 2007; 29: 415-426
        • Pavenstadt H.
        • Kriz W.
        • Kretzler M.
        Cell biology of the glomerular podocyte.
        Physiol Rev. 2003; 83: 253-307
        • Mathieson P.W.
        Proteinuria and immunity—an overstated relationship?.
        N Engl J Med. 2008; 359: 2492-2494
        • Meyrier A.Y.
        Treatment of focal segmental glomerulosclerosis with immunophilin modulation: when did we stop thinking about pathogenesis?.
        Kidney Int. 2009; 76: 487-491
        • Winkler C.A.
        • Nelson G.
        • Oleksyk T.K.
        • Nava M.B.
        • Kopp J.B.
        Genetics of focal segmental glomerulosclerosis and human immunodeficiency virus-associated collapsing glomerulopathy: the role of MYH9 genetic variation.
        Semin Nephrol. 2010; 30: 111-125
        • Genovese G.
        • Friedman D.J.
        • Ross M.D.
        • et al.
        Association of trypanolytic ApoL1 variants with kidney disease in African Americans.
        Science. 2010; 329: 841-845
        • Freedman B.I.
        • Kopp J.B.
        • Langefeld C.D.
        • et al.
        The apolipoprotein L1 (APOL1) gene and nondiabetic nephropathy in African Americans.
        J Am Soc Nephrol. 2010; 21: 1422-1426
        • Genovese G.
        • Tonna S.J.
        • Knob A.U.
        • et al.
        A risk allele for focal segmental glomerulosclerosis in African Americans is located within a region containing APOL1 and MYH9.
        Kidney Int. 2010; 78: 698-704