Case 1-2025: A 35-Year-Old Woman with Shortness of Breath and Edema in the Legs

A 35-year-old woman presented with postpartum shortness of breath and progressive leg edema. Initially admitted for preeclampsia evaluation during pregnancy, she exhibited nephrotic-range proteinuria and hypoalbuminemia. Post-delivery, her symptoms persisted, and a kidney biopsy revealed focal segmental glomerulosclerosis (FSGS) with collapsing features. Despite treatment with glucocorticoids, she experienced relapse, prompting combination therapy with rituximab and cyclophosphamide, leading to partial remission. The case underscores the diagnostic challenge of differentiating preeclampsia from primary glomerular diseases in pregnancy and highlights FSGS as a cause of postpartum nephrotic syndrome.

A 35-year-old woman presented with postpartum shortness of breath and progressive leg edema. Initially admitted for preeclampsia evaluation during pregnancy, she exhibited nephrotic-range proteinuria and hypoalbuminemia. Post-delivery, her symptoms persisted, and a kidney biopsy revealed focal segmental glomerulosclerosis (FSGS) with collapsing features. Despite treatment with glucocorticoids, she experienced relapse, prompting combination therapy with rituximab and cyclophosphamide, leading to partial remission. The case underscores the diagnostic challenge of differentiating preeclampsia from primary glomerular diseases in pregnancy and highlights FSGS as a cause of postpartum nephrotic syndrome.