Diagnose This (February 7, 2022)

In a patient with subnephrotic proteinuria, negative immunofluorescence, and segmental foot process effacement, what is your diagnosis?

​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​

Answer: Focal and Segmental Glomerulosclerosis, Favor Secondary

The biopsy shows sclerosis involving a portion of the glomerular tuft (segmental) of some, but not all, glomeruli (focal). These findings are consistent with focal and segmental glomerulosclerosis, a morphological lesion that reflects not a single disease entity, but can result from multiple etiologies (genetic, viral, drug-induced, hyperfiltration-related, among others). The presence of nephrotic syndrome and diffuse foot process effacement favors a primary FSGS, while the absence of the later favors secondary FSGS.

References:

KDIGO 2021 Clinical Practice Guideline For The Management of Glomerular Diseases