Hulter H N, Bonner E L
Arch Intern Med. 1980 Mar;140(3):403-5.
Acute oliguric renal failure previously was reported to develop in patients with preexisting idiopathic nephrotic syndrome in association with clinical evidence of vascular volume depletion. We describe an 81-year-old man without recent proteinuria or evidence of preexisting nephrotic syndrome in whom acute oliguric renal failure developed. Renal biopsy disclosed minimal change disease. Nephrotic range proteinuria without severe hypoalbuminemia was detected during the 25-day course of oliguric renal failure. Renal vein thrombosis was excluded. Urine sodium concentration and fractional sodium excretion were reduced, yet left ventricular filling pressure was not subnormal and could be increased to supernormal levels without improvement in glomerular filtration rate. Oliguria and azotemia were corrected following initiation of glucocorticoid therapy. This case suggests that lipoid nephrosis can appear as acute oliguric renal failure without historical or physical evidence of preexisting nephrotic syndrome.
既往有报道称，先前存在特发性肾病综合征的患者会发生急性少尿性肾衰竭，并伴有血管容量减少的临床证据。我们描述了一名81岁男性，近期无蛋白尿，也无先前存在肾病综合征的证据，但发生了急性少尿性肾衰竭。肾活检显示为微小病变病。在少尿性肾衰竭的25天病程中，检测到肾病范围蛋白尿，但无严重低白蛋白血症。排除了肾静脉血栓形成。尿钠浓度和钠排泄分数降低，但左心室充盈压未低于正常，且在肾小球滤过率无改善的情况下可升至超常水平。糖皮质激素治疗开始后，少尿和氮质血症得到纠正。该病例提示，脂性肾病可表现为急性少尿性肾衰竭，而无先前存在肾病综合征的病史或体征证据。
