[Therapeutic bilateral renal artery embolization in the nephrotic syndrome]

Amyloidosis with renal involvement was diagnosed in a 52-year-old man with Crohn's disease for 15 years. A severe nephrotic syndrome developed (proteinuria 40 g daily) with oedema and arterial hypotension (80/60 mm Hg). As adequate substitution treatment was not possible an attempt at medical renal ablation was made with a combination of captopril (25 mg daily), frusemide (80 mg daily) and indomethacin (200 mg daily). The proteinuria decreased to 18 g daily, but serum creatinine concentration rose to 5.8 mg/dl so that chronic haemodialysis had to be undertaken. Yet the patient's clinical state hardly improved and, because of his poor general condition, bilateral nephrectomy was contraindicated. In consequence bilateral catheter embolization of the renal arteries was performed. The urinary protein loss fell at once to 0.5 g daily. Serum protein rose from 3.1 g/dl under substitution to 5.7 g/dl without. During the following six months, while on chronic haemodialysis, the nephrotic syndrome did not recur. However, cardiac involvement in the amyloidosis was demonstrated so that the prognosis is poor. Permanent bilateral embolization of the renal arteries is a feasible method of managing a treatment-resistant nephrotic syndrome in selected patients.