Idiopathic Focal Segmental Glomerulosclerosis, Nephrotic Syndrome and Steroid Psychosis: A Case Report in Enugu, Nigeria, and Review of Literature

摘要

Background: Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome in adults in Sub-Saharan Africa. The nephrosis usually responds well to steroid therapy but alternative therapy may be needed, following steroid toxicity. Aim: We thus report a case of idiopathic FSGS that manifested as nephrotic syndrome that initially responded to steroid therapy but later was controlled with Azathioprine following steroid-induced psychosis. Findings: Patient was a 32-year old man who developed features of nephrotic syndrome and was found to have biochemical evidence of hypoalbuminemia, low density lipoprotein hypercholesterolemia and nephrotic proteinuria. Renal biopsy histology showed features of FSGS. He was commenced on oral steroid therapy, hematenics, an antiplatelet, a proton pump inhibitor and loop diuretics. Though the edema regressed he developed acute psychosis. The steroid was discontinued, while antipsychotic therapy and Azathioprine were added. The features of psychosis resolved. Nephrosis also remitted. Conclusion: This case report of FSGS that presented as nephrotic syndrome in an adult in Enugu, Nigeria-one of the four cases of steroid-induced psychosis we observed in five years-shows that steroid-induced psychosis is rare in this area and could be addressed by withdrawing the steroid and instituting antipsychotic therapy. It further shows that the nephrosis in idiopathic FSGS could also respond well to isolated Azathioprine therapy in our setting.