[Severe nephrotic syndrome with reversible acute kidney failure in lupus-associated membranous nephropathy].
METHODS
A 20 year old, previously healthy woman presented with a four week history of progressive oedema of the legs and the eyelids and a weight gain of 10 kg.


METHODS
Biochemical tests revealed a nephrotic syndrome with a protein-loss in urine of 13.6 g/24 hours and a serum-albumin of 1.2 g/dl. Serological tests showed positive response for antinuclear antibodies, anti-double-stranded-DNA antibodies and cardiolipin antibodies. Renal histology revealed a lupus-associated diffuse membranous nephropathy (WHO-type Vd).


METHODS
We first started a treatment regimen with oral steroids and intravenous loop-diuretics without improvement of the nephrotic syndrome. Two weeks after initial presentation the patient developed dialysis-dependent, acute renal failure. Having excluded a renal vein-thrombosis and the transition to diffuse proliferative form of the glomerulonephritis we suggested a nephrotic etiology of the acute renal failure. We initiated cyclophosphamide pulse-therapy which led to dramatic improvement of the nephrotic syndrome after the first cycle with reduction of protein-loss to 6 g/24 hours. Concurrently renal function recovered and treatment with hemodialysis could be stopped after 3 weeks.


CONCLUSIONS
Acute renal failure in nephrotic syndrome has also to be considered in an acute form of a membranous lupus nephritis. Renal recovery is much better when acute renal failure is caused by nephrotic syndrome.
Abteilung für Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus, Stuttgart. christiane.pauli-magnus@ikp-stuttgart.de
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Pauli-Magnus
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Mettang
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Kuhlmann
D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004247:DNA / Q000276:immunology; D004232:Diuretics / Q000627:therapeutic use; D004487:Edema / Q000209:etiology; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007668:Kidney / Q000473:pathology; D008181:Lupus Nephritis / Q000150:complications* / Q000175:diagnosis; D008788:Metolazone / Q000627:therapeutic use; D009404:Nephrotic Syndrome / Q000150:complications* / Q000175:diagnosis; D010644:Phenprocoumon / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011507:Proteinuria / Q000652:urine; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis
D017153:Antibodies, Anticardiolipin; D000974:Antibodies, Antinuclear; D000925:Anticoagulants; D018501:Antirheumatic Agents; D004232:Diuretics; D005938:Glucocorticoids; D012709:Serum Albumin; D005665:Furosemide; D003520:Cyclophosphamide; D004247:DNA; D011239:Prednisolone; D010644:Phenprocoumon; D008788:Metolazone
Schweres nephrotisches Syndrom mit reversiblem akuten Nierenversagen bei lupusassoziierter membranöser Nephropathie.