Background: Collapsing Glomerulopathy is a pathologically and clinically distinct variant of FSGS with poor prognosis.Hemodynamic disturbances may play a role in the development of the pattern of CG in renal allografts. We first report a series of cases diagnosed with antibody mediated rejection have the characteristics of collapsing glomerulopathy, and want to find the clinical and histological characteristics, also try to find the probable pathogenesis of these cases.

Method: Total ten cases have the characteristics of collapsing glomerulopathy according to previous report from 2003 to 2017 in our center.Ten recurrent FSGS patients(rFSGS) and 10 chronic antibody mediated rejection(CAMR) patients with proteinuria less than 1g/24h were selected as control groups.We analyzed the clinical and the histological characteristics. The markers of podocyte were stained in these cases.

Results: Ten cases from 36months to 120months after renal transplantation matched the characteristics of collapsing glomerulopathy combined antibody-mediated rejection. The serum creatinine ranged from 1.8 to 5.9mg/dl(similar to CAMR group). The 24h proteinuria range from 3.57 to 10.1g/24h and plasma albumin range from 21 to 31g/L(similar to rFSGS group). Histological analysis showed glomerulitis(10/10),peritubular capillary inflammation(10/10) , transplant glomerulopathy(5/10) , C4d positive in PTC(5/10) which were similar to CAMR group. FSGS pattern(10/10), podocyte proliferation(10/10) were similar to rFSGS group. Electron microscopy show that swollen podocyte and obvious effacement of podocyte process, no obvious electronic density in podocyte , epithelium and subendothelial. Nephorin and podocin staining were partial lack in podocytes, Tle4 staining were positive in these podocyte, The HLA-DR and AT-II staining were negative in podocyte. they received rituximab(3), plasma exchange(1) and IVIG(4). The prognosis of these patients were poor than rFSGS group and CAMR group

Conclusion: We reported a series of cases with collapsing glomerulopathy combined antibody mediated rejection. We consider the probably pathogenesis of these cases was related to the alloimmune response to the podocyte of renal allograft. The diagnostic terms of transplant podocytopathy was better than collapsing glomerulopathy in these patients.

CITATION INFORMATION: Wen J., Zhang M., Xu F., Chen J., Cheng D., Ni X., Li X. FSGS Pattern with Podocyte Proliferation and Heavy Proteinuria Combined Late Antibody Mediated Rejection of Renal Allograft: Collapsing Glomerulopathy or Transplant Podocytopathy? Am J Transplant. 2017;17 (suppl 3).

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