Acute renal failure in children with idiopathic nephrotic syndrome

Abstract

Acute renal failure (ARF) is an uncommon but alarming complication of idiopathic nephrotic syndrome. The renal failure could be secondary to causes evident from the history and evaluation, such as severe intravascular volume depletion, acute tubular necrosis, allergic interstitial nephritis, bilateral renal vein thrombosis, acute pyelonephritis, or rapid progression of the original glomerular disease. It may be termed idiopathic if the underlying cause is undetermined. We present three children with idiopathic nephrotic syndrome who were admitted with acute renal failure. One case was due to drug-induced allergic interstitial nephritis. The other two were idiopathic in nature. Improvement in renal function occurred in the three patients over a variable period of 10 days to 4 weeks. After careful exclusion of well-known causes of acute renal failure, idiopathic acute renal failure (IARF) should be considered as a diagnostic possibility in these patients. The exact pathophysiology of IARF is not understood. Possible proposed explanations include interstitial edema, tubular obstruction, altered glomerular permeability, and unrecognized hypovolemia.

Acute interstitial nephritis predisposed a six-year-old girl to minimal change nephrotic syndrome

“…There is confusion between ATIN and acute renal failure (ARF) secondary to minimal change nephrotic syndrome (MCNS). Complications from ARF are not rare, even in childhood MCNS [14], but ARF secondary to MCNS does not show marked proximal tubular dysfunctions such as those observed in this case. The use of FETP and FEb2MG was helpful when interpretating the degree of proteinuria with different GFR and different pathophysiologies.…”

Perbedaan Laju Filtrasi Glomerulus Berdasarkan Kadar Kreatinin dan Cystatin C Serum pada Sindrom Nefrotik Anak

“…Patogenesis terjadinya GnGA karena timbulnya keadaan hipovolemia disebabkan hipoalbuminemia yang ditandai dengan penurunan LFG. 10,12,13 Penilaian LFG dapat dilakukan berdasarkan kadar kreatinin dan cystatin C serum. 16 Pengukuran LFG (laju filtrasi glomerulus) dengan kreatinin menggunakan rumus formula Schwartz memiliki nilai lebih tinggi dibandingkan cystatin C rumus formula Filler.…”

“…4 Gangguan ginjal akut (GnGA) merupakan salah satu komplikasi dari SN yang sering dipresipitasi oleh hipovolemia dan ditandai dengan adanya penurunan LFG. [8][9][10] Teknik untuk menilai LFG dapat dilakukan dengan penanda endogen dan eksogen. Penanda eksogen adalah inulin, 51-cr-EDTA, 99mTc lebeled diethylene triamine penta acetic acid (DTPA) or 125-labeled iothalamate.…”

Hubungan Kadar Albumin Serum dengan Neutrophil Gelatinase-Associated Lipocalin Urine pada Penderita Sindrom Nefrotik Anak

“…Edema interstisial yang terbentuk akan dapat menyebabkan obstruksi dan iskemia pada tubulus ginjal. 3,4 Hipoalbuminemia menyebabkan hipovolemia dan penurunan renal blood flow (RBF) yang akan menurunkan laju filtrasi glomerulus (LFG). 5 Renal blood flow dan LFG yang menurun menyebabkan iskemia pada tubulus proksimal.…”

“…Edema interstisial yang terbentuk akan menyebabkan obstruksi tubulus dan iskemia pada tubulus ginjal. 3,4 Hipoalbuminemia menyebabkan hipovolemia yang menurunkan RBF dan LFG, penurunan RBF dan LFG menyebabkan selsel tubulus proksimal menjadi iskemik, 6 yang secara aktif memproduksi NGAL. 7,10 Iskemia pada sel-sel tubulus dan obstruksi pada lumen tubulus menyebabkan peningkatan kadar NGAL urine, peningkatan ini telah terjadi saat iskemia tubulus yaitu saat fase inisiasi dari acute kidney injury.…”