REVERSIBLE ACUTE-RENAL-FAILURE FROM GROSS HEMATURIA 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 da ys led to acute impairment of renal function of variable severity (pea k 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 Schonlein -Henoch purpura), two patients had acute postinfectious glomerulonephr itis, and two others had focal necrotizing (pauci-immune) glomerulonep hritis. The glomerular changes seen in the renal biopsy were not enoug h to explain per se the renal function impairment. Tubular changes, ho wever, were severe and consisted of tubular necrosis, erythrocyte cast s, erythrocyte phagocytosis by tubular cells, accompanied by interstit ial damage (oedema, red-cell extravasation, and inflammatory infiltrat es). Study of the renal biopsies by immunofluorescence revealed no ret rodiffusion of Tamm-Horsfall protein into the glomerular Bowman's spac e, a sign of obstructed tubular flow in any case. It is concluded that acute renal failure due to gross haematuria in glomerulonephritic pat ients may not occur only in IgA nephropathy, as reported so far, and i s not associated with intratubular obstruction.