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Unexplained severe acute kidney injury with rapid recovery of kidney function 11 months later after the start of high-dose steroid therapy.
MedLine Citation:
PMID:  23380388     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Our patient appears to represent a previously unrecognized variant of steroid-responsive minimal change disease (MCD)/focal and segmental glomerulosclerosis (FSGS) in which severe AKI developed even though the serum albumin was essentially normal and proteinuria was minimal. This would be a paradox because the AKI of MCD/FSGS is a manifestation of severe nephrotic syndrome. To explain this paradox, it is suggested that our patient is a rare variant of a phenomenon that is well documented in steroid-responsive MCD/FSGS, specifically, glomerular permeability to large molecules is increased (accounting for the proteinuria) but decreased to small molecules (accounting for the low glomerular filtration rate). Our patient promptly recovered kidney function on steroid therapy even though he had been oliguric and dialysis dependent for nearly 11 months. The possible pathophysiologic mechanisms for this remarkable presentation and outcome are discussed.
Authors:
Dan Roncone; Brad Rovin; Ronald Falk; Charles Nicely; Tibor Nadasdy; Samir Parikh; Lee A Hebert
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-5
Journal Detail:
Title:  Clinical nephrology     Volume:  -     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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