[Nephrotic syndrome as indication for one-stage bilateral renal embolisation (author's transl)]

A 42-year-old patient suffered from a nephrotic syndrome due to primary perireticular amyloidosis. One year after diagnosis the renal protein loss increased to 40 g/d within a short time so that sufficient substitution was no longer possible. The creatinine clearance was 7-10 ml/min so that haemodialysis was performed as a vital measure to remove excessive fluid. Two weeks later, as an alternative to surgical bilateral nephrectomy, simultaneous bilateral renal embolisation with Ethibloc was done without complications. A small artery to the left lower pole was spared from embolisation. Computer tomographic follow-up showed a residual parenchymal perfusion in the subcapsular and left lower pole areas so that metabolic functions of the renal parenchyma persisted. Plasma renin activity decreased to subnormal levels, the erythropoietin plasma level remained in the lower range of normal. "Medical binephrectomy" should be considered more often as a therapeutic alternative to surgery in therapy-resistant nephrotic syndrome on account of its advantage of preserved metabolic renal function.