Collapsing Focal Segmental Glomerulosclerosis in Dakar: Epidemiological, Clinic-biological, Histological and Therapeutic Aspects

Introduction: Collapsing Focal Segmental Glomerulosclerosis (FSGS) is a specific histological lesion of FSGS, characterized by the retraction of the glomerular tuft towards the hilum. Clinically, it leads to rapidly progressive renal failure, often requiring extra-renal purification. Available data on collapsing FSGS remain limited, prompting this study aimed at determining its prevalence compared to other types of FSGS and describing its clinical-biological presentation, etiological aspects, therapeutic approaches, and outcomes.

Patients and Methods: This is a descriptive retrospective study over 10 years, from January 1rst 2014, to January 1rst, 2024. All patients biopsied during this period with a histological report concluding a collapsing FSGS were included. Data were collected after patient consent from medical records. Data processing was performed using SPSS version 30.0.0 and Excel 2021.

Results: Twenty-eight patients with collapsing FSGS were included out of a population of 373 patients with FSGS, representing a prevalence of 7.5%. The mean age of patients was 28 years ±11.4, with a male predominance (sex ratio of 1.8). The nephrotic syndrome was noted in 16 patients (57.1%). The mean 24-hour proteinuria was 6.3±4.0g, and the mean albuminemia was 19.8mg/l. The nephrotic syndrome was noted in 14 patients (50%). End-stage renal failure was noted in 14 patients (50%) with a mean creatinemia of 48.1±1.9 mg/l. The aetiologies were dominated by HIV (14.3%). Angiotensin-converting enzyme inhibitors (ACEIs) were used in 18 patients (64.3%). For specific treatment, 4 patients were on antiretrovirals, 4 on corticosteroids, and 1 on rituximab. Regarding outcomes, 6 deaths were noted, and 11 patients were lost to follow-up. Among the 11 followed in consultation, 3 are currently on chronic dialysis, and 6 are between stages 4 and 5 of chronic kidney disease.

Conclusion: This study, despite its limitations, provided valuable insight into the epidemiological, diagnostic, and therapeutic aspects of collapsing FSGS, a rare but potentially severe lesion in young adults.

Keywords: Nephrotic Syndrome, Kidney Biopsy, HIV, Chronic Kidney Failure.