Sustained Remission Following Methylprednisolone Pulse Therapy in Patients with Idiopathic Collapsing Glomerulopathy and Acute Kidney Injury.

We report two adult patients with idiopathic collapsing glomerulopathy (CG) and acute kidney injury (AKI) who achieved sustained remission following methylprednisolone pulse (MP) therapy.Case 1: A 28-year-old male presented in May 2018 with anasarca, dyspnea, and oligoanuria.Laboratory evaluation showed anemia (hemoglobin-8.7 g/dL), severe hypoalbuminemia (1.8 g/dL), serum creatinine 8.2 mg/dL, and metabolic acidosis.Urinalysis revealed 4+ proteinuria; urine protein-creatinine ratio was 2 g/g.Serological tests for ANA, HBsAg, anti-HCV, and HIV were negative.He required four sessions of hemodialysis.Kidney biopsy demonstrated segmental glomerular collapse with podocyte hypertrophy in 3 glomeruli [Figure 1a, b], severe acute tubular necrosis (ATN), and mild interstitial fibrosis and tubular atrophy (IFTA), with negative immunofluorescence (IF).He received MP 1 g/day for three days, followed by oral prednisolone (1 mg/kg/day).Complete remission was achieved, steroids were tapered over 24 weeks, and he remained relapsefree during 7 years of follow-up.Case 2: A 36-year-old male presented in February 2022 with pedal edema and weakness.Investigations showed anemia (hemoglobin-11 g/dL), hypoalbuminemia (2.9 g/ dL), serum creatinine 3.2 mg/dL, and 24-h proteinuria of