A 34-year-old woman presents to the clinic with complaints of persistent fatigue, swelling in her legs, and a recent increase in urination. She has a known history of HIV, diagnosed five years ago, and is currently on antiretroviral therapy, though she admits to missing several doses in the past few months due to side effects and financial constraints.

On examination, her blood pressure is elevated at 160/100 mmHg, and there is significant bilateral lower extremity oedema. Laboratory tests show a serum creatinine level of 2.2 mg/dL and a urinalysis that reveals heavy proteinuria, with the presence of red blood cells and casts. An ultrasound of the kidneys shows normal-sized kidneys, but with signs of increased echogenicity suggestive of nephron damage.

The patient is diagnosed with HIV-associated nephropathy (HIVAN), characterized by focal segmental glomerulosclerosis (FSGS). She is started on an angiotensin-converting enzyme (ACE) inhibitor to manage her blood pressure and reduce proteinuria, along with counselling to improve her adherence to antiretroviral therapy. Close monitoring of her kidney function and overall health is planned to manage her condition effectively.