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The patient is a 64-year-old male with a history of diabetes mellitus, hypertension, and hyperlipidemia, who presents with an increased creatinine of 1.8 mg/dl and proteinuria (UPCR 2.5 g/g). Serologic workup is completely negative. A renal biopsy was performed and shows nodular glomerulosclerosis (Fig 1) and arteriolar hyalinosis characteristic of diabetic glomerulopathy. Additionally, the glomeruli focally show areas of segmental glomerulosclerosis associated with endocapillary foam cells. These lesions are located at the take-off point of the proximal tubule (Fig 1) and reminiscent of the glomerular lesions seen in the tip variant of FSGS. Electron microscopy shows mesangial matrix expansion, mostly...