Acute renal failure in idiopathic nephrotic syndrome

In 4 adults with idiopathic nephrotic syndrome an acute renal failure with prolonged anuria has been observed. At renal histology 1 patient showed minimal glomerular changes and 3 showed focal glomerulosclerosis. No vascular abnormalities were seen. In all cases severe tubular lesions with casts and cell debris in the lumina were observed. In 2 patients renal function improved after 3 and 6 months, respectively; the remaining 2 died after several months from the onset of acute renal failure being still anuric. Although the pathogenesis of this complication is unknown, tubular obstruction by proteinaceous casts and vasoconstriction may play an important role. The prognosis of this complication is severe, but the possibility of spontaneous recovery even after protracted anuria cannot be ruled out.