American Journal of Hypertension Research
ISSN (Print): ISSN Pending ISSN (Online): ISSN Pending Website: Editor-in-chief: Vasilios Kotsis
Open Access
Journal Browser
American Journal of Hypertension Research. 2017, 4(1), 15-19
DOI: 10.12691/ajhr-4-1-3
Open AccessCase Report

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

Ernest Ndukaife Anyabolu1, 2,

1Department of Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria

2Department of Medicine, Imo State University Teaching Hospital, Orlu, Nigeria;Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria

Pub. Date: August 21, 2017

Cite this paper:
Ernest Ndukaife Anyabolu. Idiopathic Focal Segmental Glomerulosclerosis, Nephrotic Syndrome and Steroid Psychosis: A Case Report in Enugu, Nigeria, and Review of Literature. American Journal of Hypertension Research. 2017; 4(1):15-19. doi: 10.12691/ajhr-4-1-3


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.

focal segmental glomerulosclerosis nephrotic syndrome steroid-induced psychosis Azathioprine enugu Nigeria

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Jeremy Kiffel, Yael Rahimzada, and Howard Trachtman, FOCAL SEGMENTAL GLOMERULOSCLEROSIS AND CHRONIC KIDNEY DISASE IN PEDIATRIC PATIENTS. Adv Chronic Kidney Dis. 2011 Sep; 18(5): 332-338.
[2]  A. R. Reshi, M. A. Bhat, M. S. Najar, K. A. Banday, M. A. Naik, D. P. Singh, and F. Wani. Etiological profile of nephrotic syndrome in Kashmir. Indian J Nephrol. 2008 Jan; 18(1): 9-12.
[3]  Wilcox S.C, Tisher C, C. Handbook of Nephrology and Hypertension. Edited by Christopher S, Wilcox, C, CraigTisher. 2005. Chapter 8: 57.
[4]  Erkan E, Garcia DC, Patterson LT, Mishra J, Mitsnefes MM, Karsel FJ, et al. Induction of Renal Tubular Cell Apoptosis in Focal Segmental Glomerulosclerosis: Roles of Proteinuria and Fas-Dependent Pathways. J Am Soc Nephrol. 2005; 16: 398-407.
[5]  Aggarwal N, Appel GB. Focal Segmental Glomerulosclerosis. In: Greenberg, A (ed.): Primer on Kidney Diseases (5th ed). Philadelphia, Pa: National Kidney Foundation, Elsvier Saunder. 2009; 167-169.
[6]  Stiefel F, Breitbart W, Holland J. Corticosteroids in cancer: neuropsychiatric complications. Cancer Invest. 1989; 7(5): 479-491.
[7]  Onwubuya M, Adelusola KA, Sabageh D, K. Ezike N, Olaofe OO. Biopsy-proven renal disease in Ile-Ife, Nigeria: A histopathologic review. Indian J Nephrol. 2016; Jan-Feb; 26(1): 16-22.
[8]  Tryggvason K, Pettersson E (Karolinska Institute, Stockholm, Sweden). Causes and consequences of proteinuria: the kidney filtration barrier and progressive renal failure (Review). J Intern Med 2003; 254: 216-224.
[9]  Oviasu E, Ojogwu I,J. Another look at the NS in adult Nigerians: pathological and immunological finding, West Afri J Med. 1992; Jan-Mar; 11 (1): 18-24.
[10]  Kadiri S, Thomas JO: Focal segmental glomerulosclerosis in malignant hypertension. South African Medical Journal 2002; 92 (4): 303-305.
[11]  Olowu WA, Adelusola KA, Adefehinti O. Childhood idiopathic steroid resistant nephrotic syndrome in Southwestern Nigeria. Saudi J Kidney Dis Transpl 2010; 21: 979-990.
[12]  Haas M, Spargo BH, Coventry S: Increasing incidence of focal segmental glomerulosclerosis among adult nephropathies: A 20 year renal biopsy study. Am J Kidney Dis 1995; 26: 740-750.
[13]  D'Agati VD, Fogo AB, Bruijn AI, Jennette AI: Pathologic classification of focal segmental glomerulosclerosis: A working proposal. Am J Kidney Dis. 2004; 43: 368-382.
[14]  D'Agati, V: The many masks of focal segmental glomerulosclerosis. Kidney Int 1994; 46: 1223-1241.
[15]  Thomas DB. Focal segmental glomerulosclerosis: a morphologic diagnosis in evolution. Arch Pathol Lab Med. Feb 2009; 133(2): 217-23.
[16]  D'Agati VD. The spectrum of focal segmental glomerulosclerosis: new insights. Curr Opin Nephrol Hypertens. May 2008; 17(3): 271-81.
[17]  Stokes MB, Markowtz GS, Lin J, et al: Glomerular tip lesion: A distinct entity within the minimal change disease/FSGS spectrum. Kidney Int. 2004; 65: 1690-1702.
[18]  Principal discussant: DAVID B. BERNARD. The University Hospital and Boston University Sc/zoo! Of Medicine, Boston, Massachusetts. Extrarenal complications of the nephrotic syndrome NEPHROLOGY FORUM. Kidney International, (1988); 33 (6): 1184-1202.
[19]  Chun MJ, Korbet SM, Schwatz MM, Lewis EJ: FSGS in nephrotic adults: Presentation, prognosis, and response to therapy of the histologic variants. J Am Soc Nephrol. 2004; 15: 2169-2177.
[20]  Appel GB, Pollak M, D'Agati VD: Focal segmental glomerulosclerosis. In Johnson R, Floege J, Feehaly J (eds): Comprehensive Clinical Nephrology. Philadelphia. Mosby Elsevier. 2007, 217-230.
[21]  Pollak M: Inherited podocythopathies: FSGS and nephrotic syndrome from a genetic viewpoint. J Am Soc Nephrol. 2002; 13: 3016-3023.
[22]  Freedman BI, Hicks PJ, Bostrom MA, et al. Polymorphisms in the non-muscle myosin heavy chain 9 gene (MYH9) are strongly associated with end-stage renal disease historically attributed to hypertension in African Americans. Kidney Int. Jan 28, 2009.
[23]  Alaleh Gheissari. Focal segmental glomerulosclerosis and end-stage kidney disease in children. J Nephropharmacol. 2015; 4(2): 61-62.
[24]  Huang JP, Zhang JJ, Liu JC, Chen YN, Yao Y, Xiao HJ, Yang JY. Clinical and pathological characteristics of focal segmental glomerulosclerosis in children. Zhonghua Er Ke Za Zhi. 2004; Jul; 42(7): 516-9.
[25]  Sreepada TK Rao. Chief Editor: Vecihi Batuman, Focal Segmental Glomerulosclerosis Treatment & Management. Drugs & Diseases > Nephrology. Medscape. Updated: Jun 06, 2016
[26]  Korbet SM. Angiotensin antagonists and steroids in the treatment of focal segmental glomerulosclerosis. Semin Nephrol. Mar 2003; 23(2): 219-28.
[27]  Korbet SM. Treatment of primary focal segmental glomerulosclerosis. Kidney Int. Dec 2002; 62(6): 2301-10.
[28]  Troyanov S, Wall CA, Miller JA, et al: for the Toronto Glomerulonephritis Registry Group: Focal and segmental glomerulosclerosis: Definition and relevance of a partial remission. J Am Soc Nephrol. 2005; 16: 1061-1068.
[29]  Lopez-Medrano F, Cervera R, Trejo O, Font J, Ingelmo M. Steroid induced psychosis in systemic lupus erythematosus: a possible role of serum albumin level. Ann Rheum Dis. 2002; 22: 55-61
[30]  Brown E, Suppes T, Khan D, Carmody T. Mood changes during prednisone bursts in outpatients with asthma. J Clin Psychpharm. 2002; 22:55-61.
[31]  Rojas Rivera J, P¨¦rez M, Hurtado A, Asato C. Servicio de Nefrolog¨ªa. Hospital Nacional Arzobispo Loayza y Universidad Peruana Cayetano Heredia. 2Servicio de Patolog¨ªa Quir¨²rgica. Hospital. Nacional Guillermo Almenara Irigoyen. Factors predicting for renal survival in primary focal segmental glomerulosclerosis. Nefrolog¨ªa. 2008; 28 (4): 439-446.