Collapsing Glomerulopathy in Brazil: A Nationwide Descriptive Study.

AIM: Collapsing glomerulopathy (CG) is a glomerular disease that progresses rapidly to renal replacement therapy (RRT). Brazil is a conducive site for studies on CG because of its significant burden of infectious diseases and a high frequency of APOL1 risk variants. We described the clinical characteristics, histopathological findings, and outcomes of CG patients. METHODS: This retrospective survey analysed data from 2014 to 2022 from 18 centres of nephrology in all Brazilian regions. CG was diagnosed by kidney biopsy (KB), and the data were collected from medical records: initial symptoms, treatment, evolution to RRT. RESULTS: A total of 330 patients were included. Most patients were men (61.2%) and of Brown/Black ethnicity (72.7%). The mean age was 32 years. The most common symptoms were loss of renal function (44.2%), nephrotic proteinuria (80.07%), and hematuria (52.31%). KB revealed mild tubular atrophy and interstitial fibrosis (53.3%), moderate-to-severe interstitial inflammation (35.9%), and acute tubular necrosis (19.0%). On immunofluorescence, IgM (75.5%) and C3 (81.2%) were found to be most frequently deposited. Secondary etiologies were identified in 94 patients: HIV (13.8%), autoimmune disease (15.9%), and APOL1 high-risk genotype (48.6%, 35/72). The mean follow-up period was 13 months. Nephrotic proteinuria persisted in 78.8% of patients, and 30.5% progressed to RRT within 3 months after diagnosis. CONCLUSION: CG affects young patients, leading to RRT in one-third of cases in approximately 3 months. This multicentre study sets the baselines for risk factors and outcomes in the largest population studies on CG.