Challenges in the management of focal segmental glomerulosclerosis in a resource – constrained environment of sub-Saharan Africa - a case report and recent concepts in management

Abstract

Aim/Background: Focal segmental glomerulosclerosis (FSGS) is defined clinically by the presence of proteinuria, often in the nephrotic range, and pathologically by segmental glomerular scars involving some but not all glomeruli. It is fast becoming a notable cause of nephrotic syndrome in Nigerian adults. There are challenges in management of FSGS in resource constrained environment like in Nigeria. From available literature search there is paucity of reports on this condition.
Materials and Methods: A case report of a 42-year old man who presented with clinical evidence of Nephrotic syndrome and histological pattern of Focal Segmental Glomerulosclerosis (FSGS).
Results: There was complete remission of proteinuria in this patient on treatment with corticosteroid and other adjunctive medications. This case was chosen for reporting to highlight that FSGS is a common cause of nephrotic syndrome in adult Nigerians and some cases can remit with steroids especially on prolonged treatment. The limitations in management of FSGS in resource-constrained environment like Nigeria includes limited availability of immunoflourescence and electron microscopy to enable further differentiation of primary FSGS from secondary FSGS; a drawback with therapeutic implications.