Collapsing
focal segmental glomerulosclerosis (cFSGS) is characterized by rapid progression to
end-stage renal disease (
ESRD). We evaluated the clinicopathological spectrum of cFSGS and compared its clinical behavior to
steroid and
tacrolimus (TAC)-resistant noncollapsing
focal segmental glomerulosclerosis (FSGS). All patients (>14 years) diagnosed with cFSGS were enrolled in the study. Staining for differentiated podocyte markers such as WT 1, PAX and KI67 were performed in all patients. The outcome and histological features of cFSGS was compared with a prospectively followed cohort of
steroid and TAC-resistant noncollapsing FSGS. The study included 22 cFSGS patients and 19 cases of
steroid and TAC-resistant FSGS. Complete remission, partial remission,
steroid resistance, progression to
ESRD and death were observed in 13.6%, 4.5%, 27.3%, 36.4% and 18.2% patients, respectively. Patients with cFSGS had higher serum
creatinine and more advanced tubulointerstitial changes compared to resistant FSGS. Twenty-six percent of
therapy resistant noncollapsing FSGS progressed to
ESRD after two years of stopping TAC. However, there was no difference in progression to
ESRD between cFSGS and
therapy-resistant noncollapsing FSGS at the end of two years. Glomerular collapse in the setting of FSGS is poorly responsive to treatment and has a high rate of progression to
ESRD. The long-term prognosis of cFSGS and
steroid and TAC-resistant FSGS are similar.