Acute glomerulonephritis superimposed on focal segmental glomerulosclerosis: A case report

A 9-year-old boy was referred to our hospital because of significant hematu ria and proteinuria associated with hypocomplementemia. Although he had had a 3-year history of asymptomatic persistent proteinuria detected by urine screening of school children, he did not visit a physician. Finally, he vis ited a regional hospital, and hypocomplementemia was noted there. A percuta neous renal biopsy performed hospital day 4 revealed diffuse endocapillary proliferative glomerulonephritis with severe tubulointerstitial changes. Al though his hematuria and hypocomplementemia spontaneously subsided within a month, proteinuria remained. A renal biopsy performed 4 months after the f irst renal biopsy revealed the lesion suggesting advanced focal segmental g lomerulosclerosis (FSGS). Despite corticosteroid treatment, his proteinuria persisted, and he developed end stage renal failure. These clinical observ ation indicated that he had acute glomerulonephritis (AGN) superimposed on non-nephrotic FSGS, and that the episode of AGN might cause exacerbation of the FSGS. (C) 2000 Tohoku University Medical Press.