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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 2  |  Page : 200-202
Idiopathic Reversible Renal Failure in a Young Woman with Minimal Change Glomerulonephritis

Department of Nephrology, Dammam Central Hospital, Kanoo Kidney Center, Dammam, Saudi Arabia

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We report a 19-year-old Saudi female with nephrotic syndrome whose renal biopsy revealed findings suggestive of minimal change glomerulonephritis (MCGN). She developed oliguric renal failure requiring hemodialysis. She remained dialysis dependent for five weeks and subsequently renal function recovered fully. She remained nephrotic and responded to a six week course of corticosteroids. She was followed for two years during which she had two relapses, which responded to steroids. Acute renal failure is uncommon in MCGN and is due to acute tubular necrosis induced by hypovolemia or drugs. This patient did not have any obvious precipitating factor, which led to acute reversible renal failure.

Keywords: Minimal Change Glomerulonephritis, Renal Failure.

How to cite this article:
Malik TQ, Joseph Y T, Ghacha R, Abdelrahman M, Karkar A. Idiopathic Reversible Renal Failure in a Young Woman with Minimal Change Glomerulonephritis. Saudi J Kidney Dis Transpl 2006;17:200-2

How to cite this URL:
Malik TQ, Joseph Y T, Ghacha R, Abdelrahman M, Karkar A. Idiopathic Reversible Renal Failure in a Young Woman with Minimal Change Glomerulonephritis. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2022 Aug 15];17:200-2. Available from: https://www.sjkdt.org/text.asp?2006/17/2/200/35790

   Introduction Top

A small group of patients with minimal change glomerulonephritis (MCGN) develop acute renal failure (ARF). It has been postu­lated that reduced plasma oncotic pressure leads to a contracted volume. Treatment with diuretics, paracentesis coupled with these factors may induce significant renal hypo­perfusion and subsequent ischemic ARF. [1]

We described below a young Saudi woman with MCGN, who developed ARF with no known obvious precipitating factor.

   Case Report Top

A 19-year-old woman was admitted for evaluation of the nephrotic syndrome. She was afebrile and had a blood pressure of 130/85 mm Hg. Twenty-four hour urine protein excretion was 6.5 gm and her serum albumin was 28 gm/L; complement studies were normal and autoantibodies were negative. An abdominal ultrasound was normal. She underwent an uneventful renal biopsy. It was reported as MCGN with mesangial proliferation. There were no deposits on immunofluorescence and electron microscopy was not done. Serum urea and creatinine and creatinine clearance were normal.

While the investigations were in progress and specific treatment was yet to be started, the patient became oliguric and her renal function deteriorated rapidly to reach dialysis­requiring range by the seventh day. She did not have any skin rash, arthritis, eosinophilia, eosinophiluria and was afebrile. An abdominal ultrasound was normal and there was no evidence of renal vein thrombosis, nor did she have post-biopsy intra- or peri-renal hematoma. The patient declined a second renal biopsy. She was dialyzed through an internal jugular catheter for the following five weeks at the end of which her renal function recovered sufficiently and hemo­dialysis was discontinued. However, the patient subsequently remained nephrotic and received a full course steroid treatment (60 mg/day) for six weeks.

Over the past two years, the patient has been closely monitored in the unit. She is normotensive and her renal function has stayed normal. She has had two relapses of the nephrotic syndrome, which responded to treatment with corticosteroids.

   Discussion Top

Acute renal failure is uncommon in MCGN and when it occurs, it tends to affect old hypertensive males with evidence of vascular disease. [2],[3] Mean urine protein excretion is usually important: 11.6gm/24 hours with low serum albumin: 19 gm/L. [4] ARF usually occurs less than one month after admission, and may last an average seven weeks but is usually reversible.[4],[5] Typical pathological features show acute tubular necrosis with marked edema of the tubulointerstitium. [1] More arteriosclerosis may also be seen.[3]

Besides old age, male gender, and hyper­tension, the main factors that have been postulated to predispose to ARF in MCGN are hypovolemia and drugs such as diuretics, ACEIs and NSAIDS. [4] However many studies have challenged the "plasma volume depletion" hypothesis to suggest a theory of "renal interstitial edema". [4],[6],[7],[8]

The patient presented in the above report is quite unusual, as she did not seem to have any known precipitating factors, a much rarer occurrence. [9] She is young, she is female, and she is normotensive. Her protein excretion is below 10 gm/24 hours and her serum albumin is above 25 gm/L. She was not on any medication, which could have induced ARF. The pathogenesis of MCGN is not fully understood but ARF with no obvious precipitating factor is of rare occurrence.

   References Top

1.Chamberlain MJ, Pringle A, Wrong OM. Oliguric renal failure in the nephrotic syndrome. QJ Med 1966;35:215-35.  Back to cited text no. 1    
2.Lowenstein J, Schacht RG, Baldwin DS. Renal failure in minimal change nephrotic syndrome. Am J Med 1981;10:227-33.  Back to cited text no. 2    
3.Jennette JC, Falk RJ. Adult minimal change glomerulopathy with acute renal failure. Am J kidney Dis 1990;16:432-7.  Back to cited text no. 3  [PUBMED]  
4.Smith JD, Hayslett JP. Reversible renal failure in the nephrotic syndrome. Am J Kidney Dis 1992;19:201-13.  Back to cited text no. 4  [PUBMED]  
5.Raij L, Keane WF, Leonard A, Shapiro FL. Irreversible acute renal failure in idiopathic nephrotic syndrome. Am J Med 1976; 61:207-14.  Back to cited text no. 5  [PUBMED]  
6.Hulter HN, Bonner FL. Lipoid nephrosis appearing as acute oliguric Renal Failure. Arch Intern Med 1980;140:403-5.  Back to cited text no. 6    
7.Geers AB, Koomans HA, Boer P, Dorhout Mees EJ. Plasma and Blood volumes in patients with the nephrotic syndrome. Nephron 1986;38:170-3.  Back to cited text no. 7    
8.Conolly ME, Wrong OM, Jones NF. Reversible renal failure in idiopathic nephritic syndrome with minimal glomerular changes. Lancet 1968;1:665-8.  Back to cited text no. 8  [PUBMED]  
9.Joseph RE, Kunis V, d'Agati V, Appel GB. Acute renal failure in idiopathic nephrotic syndrome (abstract) J Am Soc Nephrol 1997;8:A601.  Back to cited text no. 9    

Correspondence Address:
Tahir Qayyum Malik
Department of Nephrology, Dammam Central Hospital, Kanoo Kidney Center, Dammam
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 16903627

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