6.  What is the patient's diagnosis? Answer: The patient's diagnosis is Focal Segmental Glomerulosclerosis (FSGS), a scarring or hardening of tiny blood vessels in portions of the glomeruli of the kidneys.  FSGS damage in the glomerulus allows proteins to leak into the urine, causing nephrotic ranges (+4 or 2000mg/dL) in some cases.  Over time, this damage may cause kidney failure.  Characteristics of FSGS include foamy urine, edema, weight gain, a poor appetite, proteinuria, hypoproteinemia, and hematuria.  All of these signs and symptoms were clearly evident in the patient. FSGS is also more prevalent in African American males, also making him a likely candidate for the disease. Other pertinent information that led to this diagnosis includes the fact that the man is a drug user and possibly might have an HIV (Human Immunodeficiency Virus) infection.  HIV and drug toxicity can lead to FSGS.  Even though his blood test result was negative, the possibility of it being a false negative could have been because the blood test was taken too early on in the infection, before antibodies were present.  Therefore, the antibodies were not detected.  This suggests that he has the potential to be positive for HIV, since it can take a while before antibodies are able to be detected in the presence of viruses.  Back to Questions