Polaina Rusillo M, Borrego Utiel F J, Ruiz Avila I, Pérez Bañasco V
Complejo Hospitalario de Jaén.
Nefrologia. 2008;28(1):106-7.
Nephrotic syndrome is infrequently complicated with appearance of acute renal failure and minimal change disease is the glomerulopathy more usually involved. Pathogenesis is unclear and three possible mechanisms it has been proposed to explain the decrease of glomerular filtration rate: a severe reduction of glomerular permeability, the presence of acute tubular necrosis or an increased intrarenal pressure related with interstitial oedema. Here we present a 36 years-old-male with a nephrotic syndrome caused by focal and segmental glomerulosclerosis who developed an anuric acute renal failure. Renal function did not change despite oedema removal with haemodialysis and only after corticosteroid and cyclophosphamide therapy introduction we observed a rapid recovery of urinary output and resolution of acute renal failure. Renal biopsy did not show signs of tubular damage or obstruction with proteins nor significant interstitial oedema. Therefore, in this case we think acute renal failure was caused by a severe reduction in glomerular ultrafiltration rate and steroids were the effective treatment that allowed recovery of renal function.
肾病综合征很少并发急性肾衰竭，微小病变病是更常受累的肾小球病变。其发病机制尚不清楚，有人提出三种可能的机制来解释肾小球滤过率的降低：肾小球通透性严重降低、急性肾小管坏死的存在或与间质水肿相关的肾内压升高。在此，我们报告一名36岁男性，因局灶节段性肾小球硬化导致肾病综合征，并发展为无尿性急性肾衰竭。尽管通过血液透析消除了水肿，但肾功能并未改变，仅在引入皮质类固醇和环磷酰胺治疗后，我们观察到尿量迅速恢复，急性肾衰竭得到缓解。肾活检未显示肾小管损伤或蛋白阻塞迹象，也无明显间质水肿。因此，在这种情况下，我们认为急性肾衰竭是由肾小球超滤率严重降低引起的，而类固醇是使肾功能恢复的有效治疗方法。
