Rapidly Progressive Kidney Disease in a Patient With IgA Nephropathy and Focal Segmental Glomerulosclerosis Due to Nonadherence and Loss to Follow-Up.

We report a case of a 63-year-old Hispanic female with hypertension and prediabetes, diagnosed with IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) in 2023. Despite detailed counseling about immunosuppressive therapy, the patient initially refused treatment due to fear of medication side effects. Over two years without consistent nephrology follow-up, her condition rapidly progressed to nephrotic syndrome and end-stage renal disease (ESRD). Later, immunosuppressive therapy, including corticosteroids, mycophenolate mofetil (MMF), and targeted-release budesonide (Tarpeyo), was initiated, but her kidney function continued to worsen. This case underscores the importance of ongoing nephrology follow-up and patient re-engagement in managing progressive glomerular diseases, especially in patients who initially decline therapy.