warfarin and Glomerulosclerosis--Focal-Segmental

Acute kidney injury in the context of nephrotic syndrome is a serious and alarming clinical problem. Largely, acute kidney injury is a relatively frequent complication among patients with comorbidities while it has been independently associated with an increased risk of adverse outcomes, including death and chronic kidney disease. Nephrotic syndrome, without hematuria or with minimal hematuria, includes a list of certain glomerulopathies; minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy. In the light of primary nephrotic syndrome, pathophysiology of acute kidney injury is differentiated by the nature of the primary disease and the severity of the nephrotic state. This review aims to explore the clinical circumstances and pathogenetic mechanisms of acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies, focusing on newer perceptions regarding the pathogenesis and management of this complicated condition, for the prompt recognition and timely initiation of appropriate treatment in order to restore renal function to its baseline level. Prompt recognition of the precise cause of acute kidney injury is crucial for renal recovery. Clinical characteristics, laboratory and serological findings along with histopathological findings, if required, will reveal the implicated pathway leading to individualized approach and management.

Topics: Acute Kidney Injury; Anticoagulants; Biopsy; Calcineurin Inhibitors; Glomerulosclerosis, Focal Segmental; Humans; Kidney; Nephritis, Interstitial; Nephrotic Syndrome; Renal Veins; Thrombosis; Warfarin

Topics: Adult; Anti-Glomerular Basement Membrane Disease; Azathioprine; Child; Chlorambucil; Cyclophosphamide; Dipyridamole; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Immune Complex Diseases; Immunoglobulin A; Indomethacin; Kidney Glomerulus; Prednisone; Warfarin

Nine patients with biopsy-proven primary focal and segmental hyalinosis and sclerosis (FSHS) and steroid-resistant nephrotic syndrome were randomly allocated to either a period of 4-6 months of treatment (ciclosporin; (CS); 5-8 mg/kg/24 h and warfarin) or to a control period (warfarin alone) and then crossed over to the alternative for a further 4-6 months. Serum creatinine levels increased at a similar rate during treatment and control periods of observation. Serum albumin levels increased (p less than 0.05) and urinary protein excretion decreased (p less than 0.01) in association with the CS therapy compared to the control period of observation. No patient had complete resolution of the nephrotic syndrome. In primary FSHS, CS treatment is unlikely to produce complete resolution of nephrotic-range proteinuria but does significantly decrease urinary protein excretion.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Creatinine; Cyclosporins; Drug Resistance; Drug Therapy, Combination; Female; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Male; Middle Aged; Nephrotic Syndrome; Proteinuria; Randomized Controlled Trials as Topic; Serum Albumin; Warfarin

Topics: Acute Kidney Injury; Adult; Anticoagulants; Biopsy; Female; Glomerulosclerosis, Focal Segmental; Hematuria; Humans; Hypertension, Pulmonary; International Normalized Ratio; Lupus Erythematosus, Systemic; Lupus Nephritis; Pneumonia; Pulmonary Embolism; Warfarin

Topics: Adrenal Cortex Hormones; Adult; Anemia, Hemolytic, Autoimmune; Biopsy, Needle; Diagnosis, Differential; Follow-Up Studies; Giant Cell Arteritis; Glomerulosclerosis, Focal Segmental; Headache; Humans; Intracranial Hypertension; Male; Migraine Disorders; Sleep Apnea Syndromes; Vision Disorders; Warfarin

Topics: Azathioprine; Chlorambucil; Cyclophosphamide; Dipyridamole; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Kidney Diseases; Kidney Glomerulus; Nephritis; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisone; Warfarin

Topics: Adolescent; Cyclophosphamide; Dipyridamole; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Nephritis; Nephrotic Syndrome; Steroids; Warfarin