Reversible Acute Renal Failure in Idiopathic Nephrotic Syndrome.

Abstract

Acute renal insufficiency developed in four idiopathic nephrotic patients with minimal change or mild proliferative glomeruionephritis. The reduction in glomerular filtration rate (Qnuiin) was not m Proportion to the renal plasma flow (CPAH) as evidenced by a low filtration fraction. Diuretic therapy failed to reverse renal insufficiency, and renal biopsy showed no evidence of interstitial nephritis, acute tubular necrosis or interstitial edema. Corticosteroid therapy induced a recovery of renal function with a decrease in proteinuria. These observations suggest that acute renal insufficiency in the idiopathic nephrotic syndrome might be caused by impaired glomerular permeability. (Internal Medicine 32: 31-35, 1993)

Acute Kidney Injury in Adult Idiopathic Nephrotic Syndrome

“…Other reports also had shown prednisolone therapy improved the renal function. 6,[18][19][20][21][22] In the majority of reports, the prognosis for recovery of renal function had been good even in patients in whom dialysis was required. This study confirms renal function can recover completely in most of the patients.…”

“…The predominant role of hypovolemia in the development of nephrotic edema has been questioned and the majority of patients with nephrotic syndrome do not experience hypovolemia. [26][27][28][29] However, Furuya et al 6 had reported that four nephrotic syndrome patients with ARF had moderate to severe decrease of the effective renal plasma flow measured by p-aminohippurate clearance in condition of no hypovolemia. In the report of ARF by Vande Walle, 21 on comparing children with minimal change nephrotic syndrome with patients with minimal change nephropathy disease in remission, AKI patients had lower effective renal plasma flow.…”

“…From the relationship of AKI category with serum albumin and acute tubular injury in our study, we also think the decrease of effective renal plasma flow is one of the important factors of AKI in adult idiopathic nephrotic syndrome patients, although several other factors may contribute to the decline of acute glomerular filtration in idiopathic nephrotic syndrome, such as high intratubular pressure, low filtration fraction caused by impaired glomerular permeability, tubular obstruction by protein casts, and interstitial edema of the kidney. 6,10,11,[19][20][21][22] We recognize several limitations of this study. As this is a retrospective and single-center study, it may not be representative of all adult idiopathic nephrotic syndrome patients with AKI.…”

“…[1][2][3][4][5][6][7][8][9] In the last century, there were reports that approximately 30% of children and adults with idiopathic nephrotic syndrome had significant decrease in glomerular filtration rate (GFR). 3,4 There are no studies to report acute kidney injury (AKI) according to Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage kidney disease (RIFLE) classification in patients with idiopathic nephrotic syndrome since the establishment of new AKI definition and classification by Acute Dialysis Quality Initiative in 2004.…”

Successful relatively low-dose corticosteroid therapy for diclofenac-induced acute interstitial nephritis with severe renal failure

“…In these patients, diffuse glomerular visceral epithelial cell foot process fusion has been observed [4,8]. Furuya et al [9] reported that ARF in idiopathic nephrotic patients might result from reduced permeability of the glomerular basement membrane and corticosteroid therapy improved the alteration. In this case, filtration fraction was not measured.…”