Abstract
BACKGROUND: Proteinuria in pregnancy is often attributed to preeclampsia, but primary glomerular diseases such as focal segmental glomerulosclerosis can also present during pregnancy, complicating diagnosis and management. CASE PRESENTATION: A 29-year-old gravida 2, para 1 African woman presented at 25 weeks of gestation with generalized edema and turbid urine. Initial investigations revealed nephrotic-range proteinuria (7.2 g/24 hours), hematuria with red blood cell casts, and deteriorating renal function, with serum creatinine rising from 1.8 to 5 mg/dL within 3 days. Due to worsening renal impairment, pregnancy termination was performed, leading to partial renal recovery, though nephrotic-range proteinuria persisted. Renal biopsy at 4 months postpartum confirmed primary focal segmental glomerulosclerosis. CONCLUSIONS: Early recognition and prompt treatment of pregnancy-associated glomerular disease are vital for renal recovery. Differentiating focal segmental glomerulosclerosis from preeclampsia is essential, and targeted immunosuppressive therapy can achieve sustained remission, highlighting the need for a multidisciplinary approach.