REVERSIBLE IDIOPATHIC ACUTE-RENAL-FAILURE IN CHILDREN WITH PRIMARY NEPHROTIC SYNDROME

We describe the clinical features of four pediatric patients (20 month s to 10 years of age) in whom reversible idiopathic acute renal failur e (RIARF) developed during the course of primary nephrotic syndrome (P NS). All patients had severe PNS and were in relapse at the onset of R IARF. This complication of PNS was preceded by primary peritonitis in three of four patients. Renal biopsy done in the early phases of RIARF showed tubular epithelial changes similar to those observed in acute tubular ischemia. All patients required dialysis. Recovery of renal fu nction followed fluid removal in three of four patients. The RIARF las ted from 12 days to 1 year and was followed by complete recovery of re nal function in all patients. We conclude that (1) RIARF is a potentia l complication in children with severe PNS, (2) RIARF is associated wi th primary ischemic renal tubular injury, and (3) recognition of the r eversibility of this complication of PNS could alter long-term plans f or management of renal failure in these patients.