ACUTE-RENAL-FAILURE WITH SEVERE TUBULOINTERSTITIAL CHANGES IN A PATIENT WITH MINIMAL CHANGE NEPHROTIC SYNDROME TREATED WITH ENALAPRIL

A 35-year-old nephrotic man developed acute renal failure with serum c reatinine to 1543 micromol/l after a month of therapy with enalapril. Renal biopsy demonstrated minimal glomerular changes with fusion of po docytes, tubular necrosis with regeneration of tubular epithelial cell s, interstitial edema with focal interstitial fibrosis, and interstiti al infiltration with neutrophils, eosinophils, plasma cells and mononu clear cells. Three hemodialyses were performed in the patient during t he oliguric phase of the disease. Renal function was restored after wi thdrawal of enalapril and initiation of steroid therapy. Steroids also contributed to the improvement of the nephrotic syndrome and proteinu ria decreased from maximal ranges of 27 g/l to 2.2 g/l after six month s of the follow-up. Similar cases were previously described associated with captopril treatment, but not with enalapril.