Lipoid nephrosis appearing as acute oliguric renal failure
H. N. Hulter and E. L. Bonner Jr
Acute oliguric renal failure previously was reported to develop in patients
with preexisting idiopathic nephrotic syndrome in association with clinical
evidence of vascular volume depletion. We describe an 81-year-old man
without recent proteinuria or evidence of preexisting nephrotic syndrome in
whom acute oliguric renal failure developed. Renal biopsy disclosed minimal
change disease. Nephrotic range proteinuria without severe hypoalbuminemia
was detected during the 25-day course of oliguric renal failure. Renal vein
thrombosis was excluded. Urine sodium concentration and fractional sodium
excretion were reduced, yet left ventricular filling pressure was not
subnormal and could be increased to supernormal levels without improvement
in glomerular filtration rate. Oliguria and azotemia were corrected
following initiation of glucocorticoid therapy. This case suggests that
lipoid nephrosis can appear as acute oliguric renal failure without
historical or physical evidence of preexisting nephrotic syndrome.
