Lipoid nephrosis appearing as acute oliguric renal failure

Area of Science:

• Nephrology
• Internal Medicine

Background:

• Acute oliguric renal failure is often linked to idiopathic nephrotic syndrome with volume depletion.
• Minimal change disease typically presents with nephrotic-range proteinuria and edema.

Observation:

• An 81-year-old man presented with acute oliguric renal failure without prior nephrotic syndrome history.
• Renal biopsy revealed minimal change disease, with nephrotic-range proteinuria noted during the renal failure episode.
• Despite reduced urine sodium, left ventricular filling pressure was not low and did not improve renal function.

Findings:

• This case demonstrates minimal change disease presenting as acute oliguric renal failure.
• The patient exhibited nephrotic-range proteinuria during the acute renal failure, despite no prior history.
• Glucocorticoid therapy successfully resolved the oliguria and azotemia.

Implications:

• Lipoid nephrosis (minimal change disease) should be considered in cases of acute oliguric renal failure, even without overt signs of nephrotic syndrome.
• This presentation challenges the traditional understanding of the onset of minimal change disease.
• Early recognition and treatment with glucocorticoids can lead to recovery of renal function.