Post-Dengue Collapsing Focal Segmental Glomerulosclerosis: A Case Series of Viral Podocytopathy

Title: Post-Dengue Collapsing Focal Segmental Glomerulosclerosis: A Case Series of Viral Podocytopathy Introduction: Dengue virus infection typically causes Acute Kidney Injury (AKI) via Acute Tubular Necrosis (ATN). However, severe glomerular involvement is rare. We report a case series of Collapsing Focal Segmental Glomerulosclerosis (FSGS) presenting as a "viral podocytopathy" following severe Dengue infection. Materials & Methods: We analyzed the clinical data, laboratory profiles, and renal biopsy findings of three patients who presented with renal dysfunction and nephrotic range proteinuria following serologically confirmed severe Dengue infection at a tertiary care center. Results: Case 1 (19-year-old female) presented 9 months post-infection with delayed-onset nephrotic syndrome and renal insufficiency (Serum Creatinine 3.1 mg/dL). Biopsy revealed collapsing glomerulopathy with 30% fibrosis, resulting in CKD Stage 4. Case 2 (24-year-old male) presented 2 weeks post-infection with massive proteinuria (10.2 g/day) and AKI (Creatinine 2.1 mg/ dL). Biopsy showed acute collapsing FSGS without fibrosis; he achieved partial remission with corticosteroids. Case 3 (35-year-old female) developed dialysis-dependent AKI (Creatinine 6.5 mg/ dL) during the critical phase. Biopsy distinguished Collapsing FSGS from ATN, guiding prognosis. Conclusions: Dengue virus can act as a trigger for Collapsing FSGS, likely via cytokine-mediated podocyte injury. Early renal biopsy is essential in Dengue survivors with persistent proteinuria to distinguish this aggressive pathology from reversible ATN and to initiate timely management before irreversible fibrosis occurs.