Minimal change disease with acute renal failure: a case against the nephrosarca hypothesis.
An unusual but well-documented presentation of minimal change disease is nephrotic proteinuria and acute renal failure. One pathophysiological mechanism proposed to explain this syndrome is nephrosarca, or severe oedema of the kidney. We describe a patient with minimal change disease who presented with heavy proteinuria and acute renal failure but had no evidence of renal interstitial oedema on biopsy. Aggressive fluid removal did not reverse the acute renal failure. Renal function slowly returned concomitant with resolution of the nephrotic syndrome following corticosteroid therapy. The time profile of the clinical events is not compatible with the nephrosarca hypothesis and suggests an alternative pathophysiological model for the diminished glomerular filtration rate seen in some cases of minimal change disease.
Cameron
Mary Ann
MA
Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8885, USA.
Peri
Usha
U
Rogers
Thomas E
TE
Moe
Orson W
OW
D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy; D004487:Edema / Q000150:complications; D005919:Glomerular Filtration Rate; D005938:Glucocorticoids / Q000627:therapeutic use; D017583:Hemodiafiltration; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009402:Nephrosis, Lipoid / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D011241:Prednisone / Q000627:therapeutic use; D011507:Proteinuria / Q000209:etiology; D006435:Renal Dialysis
D005938:Glucocorticoids; D011241:Prednisone