Increased endothelin 1 expression in adult-onset minimal change nephropathy with acute renal failure.
BACKGROUND
Acute renal failure (ARF) occurs in some adult patients with minimal change nephropathy (MCN). To investigate clinical and pathological factors associated with developing ARF, we compared clinical features and kidney pathological characteristics of endothelin 1 (ET-1) expression in patients with adult-onset MCN with and without ARF.


METHODS
The patient population consisted of 53 patients consecutively diagnosed with adult-onset MCN during a 10-year period. Based on creatinine clearance, 25 patients were assigned to the ARF group and 28 patients were assigned to the non-ARF group.


RESULTS
Clinical data show that the ARF group had a higher blood pressure, higher serum cholesterol level, and lower serum albumin level than the non-ARF group. Pathological data showed more severe foot-process effacement, interstitial edema, and flattened tubular epithelium in the same group. Greater ET-1 expression was detected in vessels, tubules, and glomeruli of the ARF compared with non-ARF group. The ARF group experienced a lower steroid response rate. However, there was no significant difference in stability of remission to steroid treatment in patients who achieved a remission.


CONCLUSIONS
ARF associated with enhanced kidney ET-1 expression is a reversible complication of MCN that occurs frequently in patients with apparently expanded extracellular fluid. Presumptively, ARF may develop as an amplification of the underlying pathogenesis of MCN involved in enhanced ET-1 expression, which may be superimposed by a transient episode of circulatory insufficiency during diuretic treatment.
Chen
Chien-Liang
CL
Division of Nephrology and Department of Pathology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Fang
Hua-Chang
HC
Chou
Kang-Ju
KJ
Lee
Jennifer C
JC
Lee
Po-Tsang
PT
Chung
Hsiao-Min
HM
Wang
Jyh-Seng
JS
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004487:Edema / Q000209:etiology; D019332:Endothelin-1 / Q000096:biosynthesis*; D004847:Epithelial Cells / Q000648:ultrastructure; D045604:Extracellular Fluid / Q000378:metabolism; D005260:Female; D006801:Humans; D007678:Kidney Glomerulus / Q000648:ultrastructure; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D009404:Nephrotic Syndrome / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use; D012074:Remission Induction; D012079:Renal Circulation; D012709:Serum Albumin / Q000032:analysis; D014661:Vasoconstriction
D004232:Diuretics; D019332:Endothelin-1; D012709:Serum Albumin; D003520:Cyclophosphamide; D002784:Cholesterol; D011239:Prednisolone