A 13-year-old boy was found to have acute lymphoblastic leukemia 4 months after the diagnosis of nephrotic syndrome was made. Renal biospy revealed focal segmental glomerulosclerosis (FSGS). While his leukemia remains in remission 7+ years from diagnosis, he requires chronic hemodialysis due to renal failure. The multiple immunosuppressive antileukemia agents he received did not appear to affect the progression of his renal disease.