Nephrology Department & Transplantation Unit, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece.
Department of Pathology, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece.
Medicina (Kaunas). 2019 Jul 11;55(7):365. doi: 10.3390/medicina55070365.
Acute kidney injury in the context of nephrotic syndrome is a serious and alarming clinical problem. Largely, acute kidney injury is a relatively frequent complication among patients with comorbidities while it has been independently associated with an increased risk of adverse outcomes, including death and chronic kidney disease. Nephrotic syndrome, without hematuria or with minimal hematuria, includes a list of certain glomerulopathies; minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy. In the light of primary nephrotic syndrome, pathophysiology of acute kidney injury is differentiated by the nature of the primary disease and the severity of the nephrotic state. This review aims to explore the clinical circumstances and pathogenetic mechanisms of acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies, focusing on newer perceptions regarding the pathogenesis and management of this complicated condition, for the prompt recognition and timely initiation of appropriate treatment in order to restore renal function to its baseline level. Prompt recognition of the precise cause of acute kidney injury is crucial for renal recovery. Clinical characteristics, laboratory and serological findings along with histopathological findings, if required, will reveal the implicated pathway leading to individualized approach and management.
肾病综合征相关的急性肾损伤是一个严重且令人警惕的临床问题。在很大程度上，急性肾损伤是合并症患者中相对常见的并发症，而它与不良结局（包括死亡和慢性肾脏病）的风险增加独立相关。不伴血尿或血尿极少的肾病综合征包括一系列特定的肾小球疾病；微小病变性肾病、局灶节段性肾小球硬化和膜性肾病。根据原发性肾病综合征，急性肾损伤的病理生理学通过原发性疾病的性质和肾病综合征的严重程度来区分。本文旨在探讨原发性肾小球疾病所致肾病综合征患者急性肾损伤的临床情况和发病机制，重点关注关于该复杂疾病发病机制和管理的新观点，以便及时识别和开始适当的治疗，从而将肾功能恢复到基线水平。及时识别急性肾损伤的确切病因对肾功能恢复至关重要。临床特征、实验室和血清学发现以及必要时的组织病理学发现将揭示导致个体化方法和管理的相关途径。
