Why Nephrotic Syndrome will Lead to Acute Renal Failure

Nephrotic syndrome will cause many complications---infection, high condensation state, venous thrombosis, metabolic abnormalities of bone, calcium and endocrine, decline of renal glomerular functions and acute renal failure. Acute renal failure is the most serious complication and usually dialysis is needed. The common causes are as follows.

1. Hemodynamic change. Nephrotic syndrome patients usually have hypoalbuminemia and vascular disease especially senile patients often have renal arteriolosclerosis, so they are very sensitive to blood volume and decrease of blood pressure. Therefore surgical injury, ascites, use of diuresis and anti-hypertension medicines and loss of body fluids due to acute blood loss, vomiting and diarrhea can all further lower the blood pressure and cause sharp fall of renal perfusion and glomerular filtration rate. And acute blood loss will cause swelling, degeneration and necrosis of tubule epithelial cells resulting in acute kidney failure.

2. Renal interstitial edema. Hypoalbuminemia can cause edema in the surrounding tissues and renal interstitial edema which will oppress the renal tubules and cause the glomerular filtration rate (GFR) to decrease.

3. Vasoconstriction. In some cases, the concentration of renin will increase if patients have hypoalbuminemia and renin will cause the renal arterioles to contract and GFR to decrease. It is more common among senile patients that have vasculopathy.

4. In case of nephrotic syndrome, there are often the extensive fusion of epithelium foot process, disappear of crack holes and significant reduction of effective filtration area.

In addition, other causes include urinary tract obstruction, rapidly progressive glomerulonephritis, obstruction of the distal renal tubules by protein cast, acute interstitial nephritis, bilateral renal vein thrombosis, etc.