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Nephrology Dialysis Transplantation 2004 19(10):2642-2646; doi:10.1093/ndt/gfh332
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Nephrol Dial Transplant Vol. 19 No. 10 © ERA-EDTA 2004; all rights reserved

Case Report

Minimal change disease with acute renal failure: a case against the nephrosarca hypothesis

Mary Ann Cameron1, Usha Peri1, Thomas E. Rogers2 and Orson W. Moe1

Departments of 1 Internal Medicine and 2 Pathology, Department of Veterans Affairs Medical Center and The University of Texas Southwestern Medical Center, Dallas, TX, USA

Correspondence and offprint requests to: Orson W. Moe, MD, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8885, USA. Email: orson.moe{at}utsouthwestern.edu

An unusual but well-documented presentation of minimal change disease is nephrotic proteinuria and acute renal failure. One pathophysiological mechanism proposed to explain this syndrome is nephrosarca, or severe oedema of the kidney. We describe a patient with minimal change disease who presented with heavy proteinuria and acute renal failure but had no evidence of renal interstitial oedema on biopsy. Aggressive fluid removal did not reverse the acute renal failure. Renal function slowly returned concomitant with resolution of the nephrotic syndrome following corticosteroid therapy. The time profile of the clinical events is not compatible with the nephrosarca hypothesis and suggests an alternative pathophysiological model for the diminished glomerular filtration rate seen in some cases of minimal change disease.

Keywords: acute renal failure; glomerular filtration rate; minimal change disease; nephrosarca; proteinuria


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