My patient is a 36 year old male, diagnosed 5 years before with biopsy-proven MPGN. he was treated for a year with prednisone but was not followed-up. He came back with pedal edema and persistent proteinuria. Repeated kidney biopsy revealed FSGS. No electron microscopy was done due to financial constraints. His treatment was started on methylprednisolone at 5mg/kg/day for 3 days and cyclophosphamide at 2mg/kg/dose done every 4 weeks for 9 months. The initial evaluation after the pulse treatment showed resolution of proteinuria but after 2 months, the proteinuria remained at 3+ to 4+. He was started on a treatment with cellcept 1gm bid for the past 12 months, without apparent improvement. The Blood Pressure is controlled with Olmesartan 40mg, Enalapril 10mg bid and amlodipine of 10mg od. Creatinine is noted between 200-300umol/l.