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A 27-year-old HIV positive man comes for a re-visit after a screening urinalysis reveals strikingly elevated protein levels. The patient is currently reluctant to start antiretroviral therapy, though he is taking prophylactic antibiotics. He has a distant history of injection drug use. On exam, the patient has mild ankle edema and is slightly cachectic, but otherwise appears well. A new urinalysis reveals 3+ proteinuria without any hematuria or red cell casts. A serum albumin is 2.3 g. Which disease process is most likely to explain this patient’s proteinuria?

a. Minimal change disease

b. Focal segmental glomerulosclerosis

c. Membranoproliferative glomerulonephritis

d. Membranous nephropathy

e. IgA nephropathy

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b. Focal segmental glomerulosclerosis