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Collapsing FSGS — ESENeph MCQ

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HardGlomerulonephritisCollapsing FSGSESENeph

A 36-year-old man of African ancestry with untreated HIV presents with oedema and hypertension. Creatinine is 214 micromol/L, serum albumin 24 g/L and urine PCR is 650 mg/mmol. Renal biopsy shows segmental sclerosis with capillary tuft collapse and podocyte hyperplasia. What is the most likely diagnosis?

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Correct answer: C — Collapsing focal segmental glomerulosclerosis

Collapsing FSGS is strongly associated with HIV infection and presents with heavy proteinuria and progressive kidney impairment. Primary membranous nephropathy would show subepithelial immune deposits rather than capillary tuft collapse. Minimal change disease causes foot process effacement without segmental sclerosis on light microscopy. The pearl is that treating the underlying HIV with antiretroviral therapy is central to management alongside nephrology care.

Reference: KDIGO 2021 Glomerular Diseases Guideline; BHIVA/renal HIV guidance