Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2010  |  Volume : 21  |  Issue : 3  |  Page : 546--547

Renal artery embolization in a patient with severe nephrotic syndrome


Yalcin Solak1, Huseyin Atalay1, Ilker Polat2, Kultigin Turkmen1, Osman Koc3, Suleyman Turk1,  
1 Department of Nephrology, Meram School of Medicine, Selcuk University, Meram, Konya, Turkey
2 Department of Internal Medicine, Meram School of Medicine, Selcuk University, Meram, Konya, Turkey
3 Department of Radiology, Meram School of Medicine, Selcuk University, Meram, Konya, Turkey

Correspondence Address:
Yalcin Solak
Department of Nephrology, Meram School of Medicine, Selcuk University, Meram, Konya
Turkey




How to cite this article:
Solak Y, Atalay H, Polat I, Turkmen K, Koc O, Turk S. Renal artery embolization in a patient with severe nephrotic syndrome.Saudi J Kidney Dis Transpl 2010;21:546-547


How to cite this URL:
Solak Y, Atalay H, Polat I, Turkmen K, Koc O, Turk S. Renal artery embolization in a patient with severe nephrotic syndrome. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Dec 12 ];21:546-547
Available from: http://www.sjkdt.org/text.asp?2010/21/3/546/62722


Full Text

To the Editor,

We admitted a 31-year-old male patient with complaints of pretibial and periorbital edema. He had familial mediterranean fever (FMF) for ten years and was on colchicine therapy. On admission, he had anasarca edema. Labaratory values revealed blood urea: 66 mg/dL, creati­nine: 4 mg/dL, total protein: 4.1 mg/dL, albu­min: 2.0 mg/dL, and 24-hour-urine protein: 22 gram/day. Despite diuretic and antiproteinuric treatment, massive protein excretion and ede­ma persisted. He was started on hemodialysis due to hypervolemia and uremia. We per­formed left renal artery embolization (RAE) with polyvinyl alcohol, [Figure 1]. Due to in­tense pain, despite analgesia, after the proce­dure the patient refused to undergo right artery RAE. 24-hour-urine protein reduced to 1800 mg/day two days after the procedure, however, increased to 17 gram/day one week after that. We plan to embolize the right kidney after counseling with the patient.

One of the most serious complications of FMF is secondary amyloidosis and nephrotic syndrome. RAE is an effective therapeutic and adjuvant tool for many urological conditions, and in patients with vascular pathology or end­stage renal disease. [1] However, application of RAE is relatively rare in the setting of intrac­table nephrotic syndrome. [2] Hypoalbuminemia is related to increased mortality in hemodialy­sis patients. [3] Moreover, in case of massive los­ses from urine, it is impossible to replace it through nutritional support and/or albumin in­fusions. RAE may be a viable option in these cases. Unilateral RAE may decrease protein excretion; however, rebound increase of pro­tein loss from the contrlateral kidney may ne­cessitate the ablation of the other kidney as in our case.

References

1Schwartz MJ, Smith EB, Trost DW, Vaughan ED Jr. Renal artery embolization: Clinical indications and experience from over 100 cases. BJU Int 2007;99(4):881-6.
2Turgut F, Kanbay M, Kaya A, Uz B, Akcay A. Bilateral renal artery embolization in a case with severe proteinuria secondary to amyloi­dosis in a hemodialysis patient. Amyloid 2007; 14(2):157-8
3Lacson E Jr, Wang W, Hakim RM, Teng M, Lazarus JM. Associates of mortality and hospi­talization in hemodialysis: Potentially actionable laboratory variables and vascular access. Am J Kidney Dis 2009;53(1):79-90.