Nephrotic syndrome and chronic kidney disease in a young African patient from Saint Thomas and Prince: what is the link?

A 17-year-old black African female from Saint Thomas and Prince with growth failure and a 5-year history of frothy urine and periorbitary oedema was referred to our department for evaluation of renal insufficiency. At admission, the patient was hypertensive and malnourished, and presented with jugular engorgement, pulmonary rales, liver enlarged to 9 cm below the right costal margin and lower leg oedema. Laboratory tests revealed ferropenic anaemia (haemoglobin: 7.4 g/dL; ferritin 24.2 ng/mL, transferrin saturation 4%), eosinophilia (10.5%), renal dysfunction (urea 280 mg/dL, creatinine 7.0 mg/dL), hypoalbuminaemia (2.8 g/dL) and hyperfibrinogenaemia (550 mg/dL). Transaminases and C-reactive protein were on the normal range, and there was no hyperlipidaemia. Urinalysis showed proteinuria (>300 mg/dL) and haematuria (80 erythrocytes/μL), and daily protein excretion was 3.5 g/1.73 m2. Ultrasonography revealed normal renal size and increased cortical echogenicity of the kidneys, hepatosplenomegaly and celiac adenopathies. Chest Xray revealed cardiomegaly, and ecocardiography showed dilation of left ventricle, low ejection fraction (<10%) and restrictive diastolic filling pattern. The patient started haemodialysis. Further studies were negative for dysproteinaemias, vasculitis, systemic lupus erythematosous and viral infections, including human immunodeficiency virus infection, hepatitis B and hepatitis C. Evaluation of Plasmodium infection and tuberculosis was also negative.