DescriptionFocal segmental glomerulosclerosis (FSGS) is a histologic pattern of glomerular injury that could be mediated by circulating factors (primary FSGS) or caused by variety of pathological conditions (secondary FSGS). Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. About 85% of people with MS are diagnosed with relapsing remitting form, which can progress into a more aggressive form of the disease.
The patient's first health complaints appeared in adolescence when arterial hypertension and proteinuria was detected. At the end of 2020 patient kidney function was dynamically deteriorating, and nephrotic-range proteinuria was present. In 2021 first kidney biopsy was performed, confirming primary FSGS with diffuse podocyte injury and deposition of C3 and IgM in glomerular capillaries. Therapy with steroids was started, but no respond to treatment was achieved. Immunosuppression therapy was switched to cyclosporin. Proteinuria level decreased, but glomerular filtration rate continued to decline. In 2022 repeated kidney biopsy revealed FSGS with focal podocyte injury and severe arteriosclerosis.
In 2004 patient had an episode with impaired vision in the right eye and in 2017 had coordination disorders. MRI of the central nerve system was performed, and demyelinating lesions of specific localization were found that approved MS. From 2017 to 2022 patient received disease modifying therapy (DMT) with interferon beta-1a. In the 2022 she periodically feels sensory disturbances in the left body side. Now patient is 39 years old, she has stage IV chronic kidney disease and relapsing remitting MS with EDSS 2.0.
Conclusions. The reported case demonstrates two serious chronic diseases in a rare combination. Treatment resistant FSGS is a progressive kidney disease with poor prognosis. Most of specific DMT drugs for MS treatment are nephrotoxic and could worsen the course of the kidney disease therefore adjusting therapy can be difficult.
|Period||30 Mar 2023|
|Event title||RSU International Research Conference 2023: Knowledge for Use in Practice|
|Organiser||Rīga Stradiņš University|
|Location||Riga, LatviaShow on map|
|Degree of Recognition||International|