Unique proximal tubular cell injury and the development of acute kidney injury in adult patients with minimal change nephrotic syndrome

Oliguric acute kidney injury (AKI) with minimal change nephrotic syndrome (MCNS) has long been recognized. Several mechanisms such as hypovolemia due to hypoalbuminemia and the nephrosarca hypothesis have been proposed. However, the precise mechanism by which MCNS causes AKI has not been fully elucidated. Herein, we describe an elderly patient with AKI caused by MCNS who fully recovered after aggressive volume withdrawal by hemodialysis and administration of a glucocorticoid. A 75-year-old woman presented with diarrhea and oliguria, and laboratory examination revealed nephrotic syndrome (NS) and severe azotemia. Fluid administration had no effect on renal dysfunction, and hemodialysis was initiated. Her renal function improved upon aggressive fluid removal through hemodialysis. Renal pathological findings revealed minimal change disease with faint mesangial deposits of IgA. After administration of methylprednisolone pulse therapy followed by oral prednisolone, she achieved complete remission from NS. The clinical course of this case supports the nephrosarca hypothesis regarding the mechanism of AKI caused by MCNS. Furthermore, appropriate fluid management and kidney biopsy are also important in elderly patients with AKI caused by NS.

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Clinical and histopathological features of acute kidney injury in adult-onset minimal change nephrotic syndrome

Clinical and Experimental Nephrology ◽

10.1007/s10157-020-01992-8 ◽

2020 ◽

Author(s):

Kozo Nishide ◽

Shinya Nakatani ◽

Katsuhito Mori ◽

Fumiyuki Morioka ◽

Yuri Machiba ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Injury ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Adult Onset ◽

Histopathological Features

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Author Correction: Altered proximal tubular cell glucose metabolism during acute kidney injury is associated with mortality

Nature Metabolism ◽

10.1038/s42255-020-00283-6 ◽

2020 ◽

Vol 2 (9) ◽

pp. 989-989

Author(s):

David Legouis ◽

Sven-Erick Ricksten ◽

Anna Faivre ◽

Thomas Verissimo ◽

Karim Gariani ◽

...

Keyword(s):

Acute Kidney Injury ◽

Glucose Metabolism ◽

Kidney Injury ◽

Proximal Tubular Cell ◽

Tubular Cell ◽

Proximal Tubular ◽

Cell Glucose

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Altered proximal tubular cell glucose metabolism during acute kidney injury is associated with mortality

Nature Metabolism ◽

10.1038/s42255-020-0238-1 ◽

2020 ◽

Vol 2 (8) ◽

pp. 732-743

Author(s):

David Legouis ◽

Sven-Erick Ricksten ◽

Anna Faivre ◽

Thomas Verissimo ◽

Karim Gariani ◽

...

Keyword(s):

Acute Kidney Injury ◽

Glucose Metabolism ◽

Kidney Injury ◽

Proximal Tubular Cell ◽

Tubular Cell ◽

Proximal Tubular ◽

Cell Glucose

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Minimal Change Nephrotic Syndrome Sequentially Complicated by Acute Kidney Injury and Painful Skin Ulcers due to Calciphylaxis

Internal Medicine ◽

10.2169/internalmedicine.55.7180 ◽

2016 ◽

Vol 55 (22) ◽

pp. 3315-3320 ◽

Cited By ~ 3

Author(s):

Ryuta Sato ◽

Tetsu Akimoto ◽

Toshimi Imai ◽

Saki Nakagawa ◽

Mari Okada ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Injury ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Skin Ulcers

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Nephrotic syndrome and acute kidney injury following CoronaVac anti-SARS-CoV-2 vaccine

Clinical Kidney Journal ◽

10.1093/ckj/sfab155 ◽

2021 ◽

Author(s):

Suat Unver ◽

Aptullah Haholu ◽

Sukru Yildirim

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Biopsy ◽

Tubulointerstitial Nephritis ◽

Kidney Injury ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Oral Steroids ◽

Tubulointerstitial Inflammation

Abstract A 67-year-old female with type 2 diabetes mellitus developed nephrotic syndrome with in one week of receiving the first dose of SARS-CoV-2 CoronaVac vaccine. A kidney biopsy was consistent with minimal change nephrotic syndrome and treatment was symptomatic with antiproteinurik therapy and improvement in proteinuria. Edema returned within one week of the second dose of CoronaVac. In this occasion acute kidney injury and massive proteinuria were noted. In kidney biopsy, glomeruli were normal, but tubulointerstitial inflammation consistent with acute tubulointerstitial nephritis were noted. Pulse followed by oral steroids were followed by recovery of kidney function. Proteinuria decreased after initiation of cyclosporine A.

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P0309IMPACT OF ACUTE KIDNEY INJURY ON CLINICAL COURSE AND TREATMENT RESPONSE IN PATIENTS WITH MINIMAL CHANGE NEPHROTIC SYNDROME

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0309 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Hiroki Okushima ◽

Yukimasa Iwata ◽

Taisuke Takatsuka ◽

Daisuke Yoshimura ◽

Tomohiro Kawamura ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Proportional Hazards ◽

Clinical Course ◽

Kidney Injury ◽

Minimal Change Nephrotic Syndrome ◽

Cox Proportional Hazards ◽

Minimal Change ◽

Factors Associated ◽

The Mean

Abstract Background and Aims Minimal change nephrotic syndrome (MCNS) has acute onset and is occasionally complicated with acute kidney injury (AKI) in its clinical course. Few studies concerning factors associated with AKI and impact of AKI on clinical course and response to treatments are available to date. Thus, we assessed the prevalence of and factors associated with AKI and its effect on clinical course in MCNS patients. Method Single center retrospective cohort study was conducted on 72 biopsy-proven MCNS patients presented to Osaka General Medical Center, between January 2006 and December 2016. Multivariate logistic regression analysis and Cox proportional hazards analysis were used to assess contributing factors to AKI and its effect on the duration until remission. Results Median age was 58 years and 50% were male. At first presentation, the mean albumin and total cholesterol were 1.7±0.5g/dl and 402±118mg/dl, respectively. The mean urinary protein and eGFR were 12.8±8.2g/gCr and 60.1±29.4ml/min/1.73m2, respectively. A total of 29 patients (40%) had AKI and 10 of them needed renal replacement therapy (RRT). Corticosteroid and cyclosporine A were used in 66 (91%) and 3 (4%) patients, respectively for initial treatment and 3 patients (4%) received neither. 67 patients (93%) achieved complete remission (CR) with a median duration of 18 days after treatment, while 20 of those relapsed during the median follow-up period of 38 months. Logistic regression analysis revealed that older age, lower albumin, and higher urinary protein were significantly associated with AKI. Furthermore, patients with AKI had longer duration to CR induction compared with those without AKI (Log-rank test: p=0.03). Cox proportional hazards analysis showed that older age and RRT induction were associated with the delay of CR. Conclusion AKI occasionally occurs in patients with MCNS and need for RRT is associated with the delay of CR.

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Influence of acute kidney injury on the time to complete remission in adult minimal change nephrotic syndrome: a single-centre study

Nephrology ◽

10.1111/nep.12678 ◽

2016 ◽

Vol 21 (10) ◽

pp. 887-892 ◽

Cited By ~ 7

Author(s):

Daisuke Komukai ◽

Takeshi Hasegawa ◽

Nobuharu Kaneshima ◽

Mamiko Takayasu ◽

Yoshinori Sato ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Complete Remission ◽

Kidney Injury ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Single Centre ◽

Centre Study ◽

Single Centre Study

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Concurrent minimal change nephrotic syndrome and type 1 diabetes mellitus in an adult Japanese woman: a case report

BMC Nephrology ◽

10.1186/s12882-020-02071-6 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Ryuzoh Nishizono ◽

Hiroki Kogou ◽

Yuri Ishizaki ◽

Akihiro Minakawa ◽

Masao Kikuchi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Acute Kidney Injury ◽

Type 1 Diabetes ◽

Nephrotic Syndrome ◽

Type 1 Diabetes Mellitus ◽

Urine Volume ◽

Kidney Injury ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change

Abstract Background Concurrent type 1 diabetes mellitus (T1DM) and idiopathic nephrotic syndrome is rare, and most previously reported cases were in children. We report the case of an adult woman who developed T1DM and minimal change nephrotic syndrome (MCNS) nearly simultaneously. Case presentation A 24-year-old woman had first presented to another hospital with nausea, vomiting, and fatigue. She was diagnosed with diabetic ketoacidosis and T1DM on the basis of her hyperglycemia, ketoacidosis, and positive anti-glutamic acid decarboxylase antibody test result. Rapid infusion of normal saline and insulin administration alleviated hyperglycemia and ketoacidosis. Two weeks after admission, however, she developed nephrotic syndrome (NS) with rapidly decreasing urine volume. She was referred to our hospital with a diagnosis of acute kidney injury. Although she temporarily required dialysis and high doses of insulin, within 1 month NS and acute kidney injury had been alleviated by oral prednisolone and low-density lipoprotein apheresis. Renal biopsy showed minor glomerular abnormalities without diabetic nephropathy, so we diagnosed her with MCNS. Seven weeks after the discharge, NS relapsed, and cyclosporine was added to prednisolone. However, NS relapsed twice within the next 4 months, so we started her on rituximab. At 6 months after initiating rituximab therapy, she remained in complete remission. Her mother also had T1DM but not MCNS. The patient had HLA-DRB1*09:01/09:01, DQB1*03:03/03:03, and her mother had HLA-DRB1*04:05/09:01, DQB1*03:03/04:01. Conclusions Concurrent T1DM and MCNS is rare and their coexistence might be coincidental. Alternatively, they might have been caused by an underlying, unidentified genetic predisposition. Previous reports and our patient’s findings suggest that specific HLA alleles and haplotypes or a Th1/Th2 imbalance might be associated with T1DM and MCNS that occurred nearly simultaneously.

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