Focal segmental glomerulosclerosis (FSGS) in pregnancy: The case of a 27-year-old woman with nephrotic syndrome at 22 weeks of gestation.

Nephrotic syndrome (NS) in pregnancy has been associated with poor fetal outcomes. Focal segmental glomerulosclerosis (FSGS) is one of the common causes of NS and can be primary or secondary. However, there are few case reports of FSGS diagnosed in the peripartum period and the approaches to management. We report the case of a 27-year-old gravida 2 para 1 Caucasian woman diagnosed with NS at 22 weeks of gestation. Her serum creatinine was 46 µmol/L (0.48 mg/dL), serum albumin 14 g/L (1.4 g/dL) and 24-h urinary protein 9.79 g/day with no haematuria. Serology was negative for lupus, phospholipase A2 receptor antibody, hepatitis and HIV. Paraprotein screening was also negative. The patient declined a renal biopsy. Differential diagnoses at this stage included minimal change disease and FSGS. Six weeks after commencing empirical treatment with high-dose oral prednisolone, there was no response; hence, tacrolimus was initiated. Due to concern for maternal and fetal well-being, the decision was made to deliver via Caesarean section at 31 weeks, given worsening proteinuria (23.18 g/24 h). A live male infant was delivered weighing 1625 g. Renal biopsy at 4 weeks post-partum was consistent with primary FSGS. This case highlights the strategies we utilised to manage a gravid patient presenting with nephrotic syndrome at 22 weeks gestation, where diagnosis could only be confirmed on renal biopsy in the postpartum period.