Case Presentation A 38-year-old Caucasian woman with a history of type 1 diabetes since adolescence presented with several months of progressive lower limb edema. Medical History Type 1 diabetes mellitus, poorly controlled (diagnosed at age 13) Hypertension on lisinopril Laboratory Findings 24-hour proteinuria: 9 g/day Serum albumin: 2.3 g/dL Creatinine clearance: 68 mL/min eGFR: 101 mL/min/1.73m² Lipid panel: markedly elevated cholesterol and triglycerides No hematuria on urinalysis Serologies: negative for HIV, ANA, and anti-dsDNA antibodies Renal Biopsy (Light Microscopy): 29 glomeruli were observed: Four were globally sclerosed In line with the Columbia classification of FSGS, the presence of capillary loop obliteration and bordered podocyte hypertrophy   (Figure 1) Figure 1: Glomerular biopsy analyzed with light microscopy (Source: Cureus) Immunofluorescence : Positive for IgM and…