Acute renal failure in the nephrotic syndrome with minimal change disease

Acute renal failure (ARF) in minimal change nephrotic syndrome is an uncommon event generally occurring in older adults with hypertension. ARF develops soon after the onset of nephrotic syndrome and is reversible in 80% of the patients. Its course is of weeks to several months duration. Renal biopsies show an ischemic acute tubular necrosis, however, the pathogenesis of ARF is unclear, Intrarenal hemodynamic alterations and changes of the glomerular epithelial cells play possible pathogenic roles. Differential diagnosis includes severe and progressive glomerulonephritis and interstitial nephritis due to drugs, particularly diuretics and NSAIDS. No specific therapy has been identified, but the reversal of ARF after prednisone and diuretics suggests a beneficial effect, Progressive renal insufficiency and occasionally death secondary to complications although uncommon are a significant risk.