YOUNG WOMAN WITH CHRONIC AUTOIMMUNE DISEASES – FOCAL SEGMENTAL GLOMERULOSCLEROSIS WITH MULTIPLE SCLEROSIS, DIAGNOSTIC AND TREATMENT DIFFICULTIES (LATVIAN EXPERIENCE)

Objectives. Introduction. Focal 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.
Case description. 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