Background: Acute renal failure (ARF) is an uncommon but alarming complication of idiopathic nephrotic syndrome. The renal failure could be secondary to causes evident from the history and evaluation, such as severe intravascular volume depletion, acute tubular necrosis but there is no report on this population in Vietnamese adult patients. Objective: To investigate on acute renal failure complicating of nephrotic syndrome. Subjects and method: Patients with idiopathic nephrotic syndrome who were admitted with acute renal failure have been enrolled to investigate the clinical findings, laboratory check up and histology examination. Results:We present 33 patients with idiopathic nephrotic syndrome who were admitted with acute renal failure between June 1997 and June 1998. We describe the clinical and renal pathology features of these patients in whom reversible idiopathic acute renal failure developed during the course of primary nephrotic syndrome (PNS). Improvement in renal function occurred in 80% of patients over a variable period of 10 days to 14 days. The histology findings are interstitial edema, tubular obstruction. Conclusions: Acute renal failure complicating of nephritic syndrome is reversible, the exact pathophysiology of ARF is not understood. Possible causes include edema, tubular obstruction, altered glomerular permeability, and unrecognized hypovolemia.
Acute Kidney Injury/ pathology Nephrotic Syndrome ; Adult

OBJECTIVEAcute kidney injury (AKI) was recently proposed for early recognition of renal function impairment and prompt interventions. Previous study revealed that AKI was highly associated with the prognosis. However, there was rare report of AKI in renal diseases, especially in children cohorts. Therefore, we performed the prospective clinical research in children with renal diseases in our hospital, aiming to study the prevalence, the clinical characteristics and the short-term prognosis of AKI.

METHODThe study was designed as a prospective, single-center observational study.

INCLUSION CRITERIA(1) the primary diagnosis was primary nephrotic syndrome (NS), Henoch-Schoenlein purpura nephritis (HSPN) or lupus nephritis (LN), (2) the duration from the onset of the renal diseases to the admission was less than 3 months. The serum creatinine and urine output of the subjects would be prospectively monitored. AKI was defined by the adult criteria and stratified by Acute Kidney Injury Network (AKIN) criteria. The patients were followed up at 6 months and 12 months after enrollment.

RESULTBetween October 2007 and April 2009, a total of 95 children were included, including 65 cases with NS, 15 HSPN and 15 LN. Mean age was (8.9 ± 3.9) years (range 2 - 16 years). Thirty-three of the 95 patients (34.7%) fulfilled the AKI criteria, 13 patients (13.7%) were diagnosed as acute renal failure (ARF). All the AKI in children with LN and HSPN presented with serum creatinine elevation. However, 65.4% of AKI in NS presented with decreasing urine output, only 19.2% accompanied with increasing creatinine, with higher stages of urine output. Regarding the etiology, only 26.9% of AKI in NS had definite cause, most of which resulted from side-effect of cyclosporine, hypovolemia or tubule-interstitial damage, independent of glomerular diseases. In contrast, the AKI in LN and HSPN were exclusively caused by glomerular diseases. The length and costs of hospitalization of AKI group were significantly higher than non-AKI [length of hospitalization (d), 28(6 to 94) vs. 21(7 to 100), Z = -1.971, P = 0.049; cost of hospitalization (yuan), 12 035.7 (1561.7 to 94 783.1) vs. 8594.3 (1390.1 to 98 876.5), Z = -1.993, P = 0.046]. There was no significant difference in the serum creatinine at 6-month and 12-month follow-up between AKI group and non-AKI [6-month, (60.4 ± 91.8) µmol/L vs. (42.8 ± 12.2) µmol/L, t = 0.937, P = 0.358; 12-month, (48.7 ± 18.1) µmol/L vs. (47.7 ± 14.2) µmol/L, t = 0.197, P = 0.845].

CONCLUSIONThe prevalence of AKI (34.7%) was higher than that of ARF (13.7%) in children with renal diseases. Most of the AKI in NS resulted from non-glomerular diseases. In contrast, most AKI in LN and HSPN were caused by underlying glomerular diseases. The length and costs of hospitalization were significantly higher in AKI group. However, there was no significant difference in serum creatinine between AKI and non-AKI group in the follow-up at 6 months and 12 months. Further investigations on criteria for the diagnosis of AKI in children with renal diseases are still needed.

Acute Kidney Injury ; etiology ; Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Lupus Nephritis ; complications ; pathology ; Male ; Nephrotic Syndrome ; complications ; pathology ; Prospective Studies ; Purpura, Schoenlein-Henoch ; complications ; pathology ; Risk Factors

Acute Kidney Injury ; epidemiology ; pathology ; Adolescent ; Adult ; Aged ; Biopsy, Needle ; methods ; China ; epidemiology ; Female ; Glomerulonephritis, Membranoproliferative ; epidemiology ; pathology ; Humans ; Kidney ; pathology ; Kidney Diseases ; epidemiology ; pathology ; Male ; Middle Aged ; Nephrotic Syndrome ; epidemiology ; pathology ; Ultrasonography, Interventional

The use of nonsteroidal antiinflammatory drugs (NSAIDs) can be complicated by severe forms of renal dysfunction. These include fluid and electrolyte abnormalities, acute renal insufficiency due to alteration in renal hemodynamics, or interstitial nephritis and proteinuria secondary to glomerular pathology, which has the histologic characteristics of minimal change glomerulopathy (MCG). While NSAID-induced nephrotic syndrome characteristically consists of MCG with interstitial nephritis, which is the most common clinical manifestation, it rarely consists of MCG without interstitial nephritis, which has been reported in a handful of patients who took fenoprofen, ibuprofen, sulindac, diclofenac, or zomepirac. We experienced a 66-year-old female patient who presented with low serum albumin, proteinuria and generalized edema and received Geworin for about 2 year before developing symptoms. She histologically had MCG without interstitial nephritis and achieved a complete remission thirty-fifth days after discontinuing the drug. A cause-and-effect relationship of this disease to Geworin administration is strongly suggested by the resolution of the proteinuria after the drug was stopped and by no evidence of any impairment in renal function after twenty eight months of follow-up.
Acute Kidney Injury ; Aged ; Analgesics* ; Anti-Inflammatory Agents ; Antipyrine ; Diclofenac ; Edema ; Female ; Fenoprofen ; Follow-Up Studies ; Hand ; Hemodynamics ; Humans ; Ibuprofen ; Nephritis ; Nephritis, Interstitial* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pathology ; Proteinuria ; Serum Albumin ; Sulindac