Clinical and Experimental Nephrology

, Volume 14, Issue 4, pp 385–388 | Cite as

Complete remission of non-HIV collapsing glomerulopathy with deflazacort and lisinopril in an adult patient

  • Jorge Vega
  • Francisco Javier Guarda
  • Helmuth Goecke
  • Gonzalo P. Méndez
Case Report


Collapsing glomerulopathy is a form of focal segmental glomerulosclerosis that is usually associated with HIV-1 infection, and is characterized by its poor prognosis and almost inevitable progression to end-stage renal disease. Its pathological features include collapsed glomeruli, podocyte hypertrophy and hyperplasia, and pseudocrescents. This case report shows the evolution of a 58-year-old patient with non-HIV idiopathic collapsing glomerulopathy who presented with severe nephrotic syndrome and renal insufficiency and was treated with lisinopril and deflazacort, a synthetic corticosteroid that has shown fewer cosmetic effects and glucose and bone metabolism complications than prednisone. The patient responded with full recovery of renal function and normal range of protein excreted in urine after less than two years of treatment. The patient has not suffered a recurrence of his nephrotic syndrome after three years of steroid withdrawal. There is no proven therapy for collapsing glomerulopathy, and this case highlights an alternative for treating this disease with few secondary effects.


Collapsing glomerulopathy Nephrotic syndrome Deflazacort Lisinopril Focal segmental glomerulosclerosis Chronic kidney diseases Renal insufficiency 


Conflict of interest statement



  1. 1.
    Weiss MA, Daquioac E, Margolin EG, Pollak VE. Nephrotic syndrome, progressive irreversible renal failure and glomerular “collapse”: a new clinicopathological entity? Am J Kidney Dis. 1986;7(1):20–8.PubMedGoogle Scholar
  2. 2.
    Chun MJ, Korbet SM, Schwartz MM, Lewis EJ. Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants. J Am Soc Nephrol. 2004;15(8):2169–77.CrossRefPubMedGoogle Scholar
  3. 3.
    Barisoni L, Nelson PJ. Collapsing glomerulopathy: an inflammatory podocytopathy? Curr Opin Nephrol Hypertens. 2007;16(3):192–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Berggren R, Batuman V. HIV-associated renal disorders: recent insights into pathogenesis and treatment. Curr HIV/AIDS Rep. 2005;2(3):109–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Albaqumi M, Soos TJ, Barisoni L, Nelson PJ. Collapsing glomerulopathy. J Am Soc Nephrol. 2006;17(10):2854–63.Google Scholar
  6. 6.
    Laurinavicus A, Rennke HG. Collapsing glomerulopathy: a new pattern of renal injury. Semin Diagn Pathol. 2002;19(3):106–15.Google Scholar
  7. 7.
    D’agati V, Fogo A, Brujin J, Jennette JC. Pathologic classification of focal segmental glomerulosclerosis: a working proposal. Am J Kidney Dis. 2004;43(2):368–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Herman ES, Klotman PE. HIV-associated nephropathy: epidemiology, pathogenesis, and treatment. Semin Nephrol. 2003;23(2):200–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Albaqumi M, Barisoni L. Current views on collapsing glomerulopathy. J Am Soc Nephrol. 2008;19(7):1276–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Walker BR. Deflazacort: towards selective glucocorticoid receptor modulation. Clin Endocrinol (Oxf). 2000;52(1):13–5.CrossRefGoogle Scholar
  11. 11.
    González-Pérez O, Luquin S, García-Estrada J, Ramos-Remus C. Deflazacort: a glucocorticoid with few metabolic adverse effects but important immunosuppressive activity. Adv Ther. 2007;24(5):1052–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Schwimmer JA, Markowitz GS, Valeri A, Appel GB. Collapsing glomerulopathy. Semin Nephrol. 2003;23(2):209–18.CrossRefPubMedGoogle Scholar
  13. 13.
    Grcevska L, Polenakovic M. Collapsing glomerulopathy: clinical characteristics and follow-up. Am J Kidney Dis. 1999;33(4):801–3.CrossRefGoogle Scholar
  14. 14.
    Olgaard K, Storm T, Van Wowern N, et al. Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandibule of nephritic patients: a double-blind study on the high-dose, long-term effects of prednisone versus deflazacort. Calcif Tissue Int. 1992;50(6):490–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Mollmann H, Hochlaus G, Rohatagi S, Barth J, Derendorf H. Pharmacokinetic/pharmacodynamic evaluation of deflazacort in comparison to methylprednisolone and prednisone. Pharm Res. 1995;12(7):1096–100.CrossRefPubMedGoogle Scholar
  16. 16.
    González-Castañeda R, Castellanos-Alvarado E, Flores-Márquez M, et al. Deflazacort induced stronger immunosuppression than expected. Clin Rheumatol. 2007;26(6):935–40.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2010

Authors and Affiliations

  • Jorge Vega
    • 1
    • 2
  • Francisco Javier Guarda
    • 3
  • Helmuth Goecke
    • 1
    • 2
  • Gonzalo P. Méndez
    • 4
  1. 1.Departamento de NefrologíaDiálisis y Trasplante, Hospital Naval A. NefViña del MarChile
  2. 2.Departamento de Medicina, Sección de Nefrología, Escuela de MedicinaUniversidad de ValparaísoValparaísoChile
  3. 3.Escuela de MedicinaUniversidad Católica de ChileSantiagoChile
  4. 4.Departamento de Anatomía Patológica, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile

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