Differential Diagnosis
- Single most likely diagnosis
- Diabetic nephropathy with secondary FSGS: This diagnosis is most likely due to the presence of severe arteriolar hyalinosis, segmental glomerulosclerosis, and the clinical context of diabetic nephropathy. The low-level immune complex deposition and extraglomerular deposits may be secondary to the underlying diabetic nephropathy.
- Other Likely diagnoses
- Secondary FSGS due to hypertensive nephrosclerosis: The presence of severe arteriolar hyalinosis could also be seen in hypertensive nephrosclerosis, which can lead to secondary FSGS.
- CNI toxicity: If there is a history of calcineurin inhibitor use, CNI toxicity could be contributing to the FSGS, especially with the presence of mild podocyte foot process effacement.
- Autoimmune disease-associated nephropathy: The low-level immune complex deposition and extraglomerular deposits suggest an underlying autoimmune disease, which could be contributing to the FSGS.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Membranoproliferative glomerulonephritis (MPGN): Although the immunofluorescence pattern is not typical for MPGN, it is a diagnosis that should not be missed due to its potential for aggressive disease and poor outcomes.
- Lupus nephritis: The presence of low-level immune complex deposition and extraglomerular deposits could be seen in lupus nephritis, which is a diagnosis that requires prompt recognition and treatment.
- Rare diagnoses
- Hereditary FSGS: Although the clinical presentation and biopsy findings do not strongly support a hereditary form of FSGS, it is a rare diagnosis that should be considered, especially if there is a family history of kidney disease.
- Monoclonal gammopathy-associated nephropathy: The presence of low-level immune complex deposition and extraglomerular deposits could be seen in monoclonal gammopathy-associated nephropathy, which is a rare diagnosis that requires further evaluation and serology studies.