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FSGS — RACP Adult Medicine MCQ

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ModerateNephrologyFSGSRACP Adult Medicine

A 30-year-old man presents with bilateral pitting oedema, frothy urine, and hypercholesterolaemia. His serum albumin is 15 g/L and urine protein is 15 g/day. He has no diabetes or hepatitis. Renal biopsy shows segmental sclerosis of some glomeruli with podocyte effacement. What is the most likely diagnosis?

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Correct answer: C — Focal segmental glomerulosclerosis

FSGS presents with nephrotic syndrome (massive proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia). Segmental sclerosis affecting some glomeruli (initially juxtamedullary) on light microscopy with podocyte effacement on EM is diagnostic. Unlike MCD, FSGS is less responsive to corticosteroids (~30–50% response rate vs ~90% in MCD). Secondary causes (HIV, heroin, obesity, genetic mutations) should be excluded. Calcineurin inhibitors may be considered for steroid-resistant FSGS.

Reference: eTG – 2025 – Nephrology; KDIGO – 2021 – Glomerular Diseases Guidelines