Complete Remission of Focal Segmental Glomerulosclerosis (FSGS) with Multiple Complications: A Case Report

Abstract

Background: The symptoms of nephrotic syndrome include severe proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Renal biopsy is essential to identify the histological subtype, which guides therapy and prognosis. Early diagnosis and treatment are crucial to prevent the progression of kidney failure. We present a case of nephrotic syndrome secondary to focal segmental glomerulosclerosis (FSGS), complicated by severe anemia, hypercoagulability, and pressure ulcers.

Case Presentation: A 25-year-old woman presented with progressive generalized edema for four months, which ultimately restricted her mobility and resulted in immobilization and a prolonged bedridden state.  She reported a decrease in urine output and foamy urine for two months. On admission, vital signs were stable. Physical examination revealed periorbital edema, pale conjunctiva, abdominal distension with striae and shifting dullness, non-pitting edema in both lower extremities and the left upper limb, and a gluteal wound with erythematous macules. Laboratory findings revealed severe normocytic normochromic anemia, hypoalbuminemia, hypercholesterolemia, and nephrotic-range proteinuria. Peripheral smear demonstrated anisopoikilocytosis, leucocytosis with immature granulocytes, and giant platelets. The direct Coombs test was positive and the d-dimer level was increased. Echocardiography revealed mild pericardial effusion, while abdominal ultrasound demonstrated gallbladder sludge with free peritoneal fluid. Doppler ultrasound of the left upper extremity showed no abnormalities, with no evidence of venous thrombus. Renal biopsy confirmed FSGS. She was diagnosed with nephrotic syndrome due to FSGS, complicated by severe anemia with a positive direct Coombs test, hypercoagulability, and pressure ulcers. Clinical improvement was achieved through the use of high dose corticosteroids, immunosuppressive therapy, and antihypertensive agents. Complete remission was achieved within six weeks.

Conclusion: This case highlights the complexity of nephrotic syndrome caused by FSGS, where timely biopsy, immunosuppressive therapy, and supportive care were key to achieving remission and improving outcomes.