Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings
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 eluci...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2020-04-01
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| Series: | Case Reports in Nephrology and Dialysis |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/507426 |
| _version_ | 1811324683422793728 |
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| author | Yuko Oyama Yoichi Iwafuchi Tetsuo Morioka Ichiei Narita |
| author_facet | Yuko Oyama Yoichi Iwafuchi Tetsuo Morioka Ichiei Narita |
| author_sort | Yuko Oyama |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T14:19:53Z |
| format | Article |
| id | doaj.art-7f6260829d774609b65d915a4690f29e |
| institution | Directory Open Access Journal |
| issn | 2296-9705 |
| language | English |
| last_indexed | 2024-04-13T14:19:53Z |
| publishDate | 2020-04-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Nephrology and Dialysis |
| spelling | doaj.art-7f6260829d774609b65d915a4690f29e2022-12-22T02:43:32ZengKarger PublishersCase Reports in Nephrology and Dialysis2296-97052020-04-01101425010.1159/000507426507426Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy FindingsYuko OyamaYoichi IwafuchiTetsuo MoriokaIchiei NaritaOliguric 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.https://www.karger.com/Article/FullText/507426acute kidney injurynephrosarca hypothesiselderly patientminimal change nephrotic syndromekidney biopsy |
| spellingShingle | Yuko Oyama Yoichi Iwafuchi Tetsuo Morioka Ichiei Narita Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings Case Reports in Nephrology and Dialysis acute kidney injury nephrosarca hypothesis elderly patient minimal change nephrotic syndrome kidney biopsy |
| title | Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings |
| title_full | Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings |
| title_fullStr | Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings |
| title_full_unstemmed | Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings |
| title_short | Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings |
| title_sort | acute kidney injury associated with minimal change nephrotic syndrome in an elderly patient successfully treated with both fluid management and specific therapy based on kidney biopsy findings |
| topic | acute kidney injury nephrosarca hypothesis elderly patient minimal change nephrotic syndrome kidney biopsy |
| url | https://www.karger.com/Article/FullText/507426 |
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