Oyama Yuko, Iwafuchi Yoichi, Morioka Tetsuo, Narita Ichiei
Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, Japan.
Department of Internal Medicine, Kidney Center, Shinrakuen Hospital, Niigata, Japan.
Case Rep Nephrol Dial. 2020 Apr 22;10(1):42-50. doi: 10.1159/000507426. eCollection 2020 Jan-Apr.
Oliguric acute kidney injury (AKI) with minimal change nephrotic syndrome (MCNS) has long been recognized. Several mechanisms such as hypovolemia due to hypoalbuminemia and the nephrosarca hypothesis have been proposed. However, the precise mechanism by which MCNS causes AKI has not been fully elucidated. Herein, we describe an elderly patient with AKI caused by MCNS who fully recovered after aggressive volume withdrawal by hemodialysis and administration of a glucocorticoid. A 75-year-old woman presented with diarrhea and oliguria, and laboratory examination revealed nephrotic syndrome (NS) and severe azotemia. Fluid administration had no effect on renal dysfunction, and hemodialysis was initiated. Her renal function improved upon aggressive fluid removal through hemodialysis. Renal pathological findings revealed minimal change disease with faint mesangial deposits of IgA. After administration of methylprednisolone pulse therapy followed by oral prednisolone, she achieved complete remission from NS. The clinical course of this case supports the nephrosarca hypothesis regarding the mechanism of AKI caused by MCNS. Furthermore, appropriate fluid management and kidney biopsy are also important in elderly patients with AKI caused by NS.
少尿型急性肾损伤（AKI）合并微小病变肾病综合征（MCNS）早已为人所知。已经提出了几种机制，如低白蛋白血症导致的血容量不足和肾性水肿假说。然而，MCNS导致AKI的确切机制尚未完全阐明。在此，我们描述了一名由MCNS引起AKI的老年患者，在通过血液透析积极进行容量清除并给予糖皮质激素后完全康复。一名75岁女性出现腹泻和少尿，实验室检查显示肾病综合征（NS）和严重氮质血症。补液对肾功能障碍无效，遂开始血液透析。通过血液透析积极清除液体后，她的肾功能得到改善。肾脏病理检查结果显示为微小病变，伴有轻度系膜IgA沉积。给予甲泼尼龙冲击治疗后口服泼尼松龙，她的NS完全缓解。该病例的临床过程支持了关于MCNS导致AKI机制的肾性水肿假说。此外，对于由NS引起AKI的老年患者，适当的液体管理和肾活检也很重要。
