Focal segmental glomerulosclerosis

Today, we discussed an outpatient clinic case of a patient with longstanding refractory htn and CKD stage 3, found to have nephrotic range proteinuria with biopsy showing FSGS.

Learning points:

We discussed common potential side effects of antihypertensives as our patient had: peripheral edema with amlodipine, bradycardia with carvedilol, cough with lisinopril, and hyponatremia with chlorthalidone.

Initial diagnostic steps of CKD for the general internist, including:

  1. checking serum electrolytes, CBC, lipids, UA, calcium, phosphorus, PTH, albumin and renal ultrasound
  2. specific testing pending the clinical scenario including ANA, hep B, hep C, HIV, ANCA, SPEP and UPEP
  3. when to refer: persistent proteinuria, nephritic syndrome, sustained hematuria, no clear cause of CKD, rapid kidney failure

Lastly, we discussed the differential of nephrotic range proteinuria, focusing specificially on FSGS. We categorized as primary or secondary FSGS with secondary FSGS having many potential causes (HIV, pamidronate, heroin, congenital, hyperfiltration due to prior nephron loss, obesity, or vesicoureteral reflux).