Collapsing Glomerulopathy in a Patient With Myelodysplastic Syndrome With Isolated del(5q): A Case Report

Nephrotic syndrome associated with myelodysplastic syndromes (MDSs) is rare, and collapsing glomerulopathy (CG) in this condition is extremely uncommon. We report a case of CG in a 62-year-old man who presented with generalized edema, severe anemia, acute kidney injury, and nephrotic-range proteinuria. Laboratory tests showed hypoalbuminemia and elevated serum creatinine, whereas kidney ultrasound showed normal-sized kidneys with increased parenchymal echogenicity. Kidney biopsy confirmed a diagnosis of CG, and subsequent bone marrow biopsy showed myelodysplastic syndromes with isolated 5q deletion (MDS-del(5q)) and low blast count. The patient was treated with oxymetholone, erythropoietin, and lenalidomide. Despite treatment, his kidney function deteriorated, leading to kidney failure with replacement therapy. To our knowledge, CG is a rare cause of nephrotic syndrome in patients with MDS, particularly in those with MDS-del(5q), and has not been previously reported. This case underscores the importance of considering hematologic malignancies, including MDS, in the differential diagnosis of CG, especially when accompanied by cytopenias. Early recognition of the underlying etiology is essential for guiding treatment and may offer the opportunity to modify disease progression.