Reversible acute renal failure from gross haematuria due to glomerulonephritis : not only in IgA nephropathy and not associated with intratubular obstruction

Seven patients with acute renal failure due to gross haematuria caused by glomerulonephritis are described. Gross haematuria lasting 4-40 days led to acute impairment of renal function of variable severity (peak plasma creatinine 1.3-12 mg/dl) and duration. While partial recovery of renal function o...

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Bibliographic Details
Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 1995, Vol.10 (5), p.624-629
Main Authors: FOGAZZI, G. B, IMBASCIATI, E, MORONI, G, SCALIA, A, MIHATSCH, M. J, PONTICELLI, C
Format: Article
Language:English
Subjects:
Acute Kidney Injury - etiology
Acute Kidney Injury - metabolism
Acute Kidney Injury - pathology
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Glomerulonephritis - complications
Glomerulonephritis - metabolism
Glomerulonephritis - pathology
Hematuria - complications
Hematuria - metabolism
Hematuria - pathology
Humans
Kidney Tubules - pathology
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Renal failure
Retrospective Studies
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Summary:Seven patients with acute renal failure due to gross haematuria caused by glomerulonephritis are described. Gross haematuria lasting 4-40 days led to acute impairment of renal function of variable severity (peak plasma creatinine 1.3-12 mg/dl) and duration. While partial recovery of renal function occurred in all patients within few days, complete remission was observed only some months later. Three patients had IgA nephropathy (2 the primary form and 1 nephritis secondary to Schönlein-Henoch purpura), two patients had acute postinfectious glomerulonephritis, and two others had focal necrotizing (pauci-immune) glomerulonephritis. The glomerular changes seen in the renal biopsy were not enough to explain per se the renal function impairment. Tubular changes, however, were severe and consisted of tubular necrosis, erythrocyte casts, erythrocyte phagocytosis by tubular cells, accompanied by interstitial damage (oedema, red-cell extravasation, and inflammatory infiltrates). Study of the renal biopsies by immunofluorescence revealed no retrodiffusion of Tamm-Horsfall protein into the glomerular Bowman's space, a sign of obstructed tubular flow in any case. It is concluded that acute renal failure due to gross haematuria in glomerulonephritic patients may not occur only in IgA nephropathy, as reported so far, and is not associated with intratubular obstruction.
ISSN:0931-0509
1460-2385
1460-2385
DOI:10.1093/ndt/10.5.624