Urinary Frequency and Polydipsia Mimicking Diabetes Mellitus: Obesity-Related Secondary Focal Segmental Glomerulosclerosis with Concurrent Overactive Bladder — A Case Report
Abstract
Abstract Background Focal segmental glomerulosclerosis (FSGS) is a histopathological pattern of podocyte injury with primary, secondary, and genetic forms that differ in treatment and prognosis. Correct classification is important because secondary (adaptive) forms, including obesity-related glomerulopathy, do not respond to immunosuppression. Obesity-related secondary FSGS may produce heavy proteinuria yet preserved serum albumin, and chronic urinary frequency may reflect lower-urinary-tract rather than metabolic disease. Case presentation A 23-year-old man with class II obesity presented with a two-year history of urinary frequency, polydipsia and intermittent hand paraesthesia, a picture initially suggestive of diabetes mellitus. Evaluation showed nephrotic-range proteinuria, mildly reduced estimated glomerular filtration rate (eGFR), preserved serum albumin, dyslipidaemia and hyperuricaemia, without diabetes mellitus, urinary obstruction or serological evidence of systemic autoimmune disease. Kidney biopsy showed segmental sclerosis with perihilar and arteriolar hyalinosis, intracapillary foam cells, capsular adhesions, and only focal mesangial (IgA/IgM) staining, consistent with a secondary (adaptive) pattern of FSGS. He was managed without immunosuppression, using an angiotensin-receptor blocker, a statin (later combined with ezetimibe), urate-lowering therapy, empagliflozin, and weight-directed tirzepatide. Renal function and metabolic parameters fluctuated, and…
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