PERCUTANEOUS TRANSCATHETER RENAL EMBOLIZATION WITH ABSOLUTE ETHANOL FOR UNCONTROLLED NEPHROTIC SYNDROME. Case reports

Tikkakoski, Tapani; Leppänen, M.; Turunen, J.; Anderson, Stuart; Södervik, Hannu

doi:10.1034/j.1600-0455.2001.042001080.x

Cited by 5 publications

(8 citation statements)

References 14 publications

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“…2). Because of the successful outcome in this case and previous reports [3, 4, 5, 6, 7, 8, 9, 10, 11], it is suggested that treatment with bilateral RAE as early as possible may be worthwhile for patients with severe proteinuria resistant to medical therapy.…”

Section: Discussionmentioning

confidence: 50%

“…No specific complications arose as a result of the regular HD. This case and selected previous reports [3, 4, 5, 6, 7, 8, 9, 10, 11] reveal important information for physicians and patients in discussing prognoses and considering the pros and cons of bilateral RAE.…”

Section: Discussionmentioning

confidence: 67%

“…vascular malformations, angiomyolipomas, and renal tumors that are not amenable to surgical resection [1, 2]. A search of the literature for the past 20 years reveals that only a few cases of renal amyloidosis [3, 4, 5, 6, 7] and severe nephrotic syndrome [8, 9, 10, 11] have resulted in bilateral renal artery embolization (RAE) for severe proteinuria. The limited use of bilateral RAE for nephrological purposes may be partly related to its tendency to destroy renal function, which results in anuria and subsequent regular dialysis.…”

Section: Introductionmentioning

confidence: 99%

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Severe Proteinuria Secondary to Amyloidosis Requiring Bilateral Renal Artery Embolization

Yeh¹,

Tseng²,

Liu

et al. 2012

Case Rep Nephrol Urol

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In the case reported here, after prolonged medical therapy resistance, severe proteinuria subsided following bilateral renal artery embolization (RAE). Thereafter, respiratory distress, anasarca edema, muscle mass, and serum albumin level improved after regular hemodialysis. Although RAE is reported to be a safe and effective therapeutic procedure, it is rarely used for severe proteinuria with prolonged medical therapy resistance. The limited use of bilateral RAE for nephrological purposes may be partly related to its tendency to destroy renal function, which results in anuria and subsequent regular dialysis. However, delayed RAE could cause the patient to reach a life-threatening cachexic state and could increase the risk of morbidity and mortality due to severe proteinuria-induced hypoalbuminemia. Our case and selected previous reports reveal important information for physicians and patients while discussing prognoses and considering the pros and cons of bilateral RAE.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

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Severe Proteinuria Secondary to Amyloidosis Requiring Bilateral Renal Artery Embolization

Yeh¹,

Tseng²,

Liu

et al. 2012

Case Rep Nephrol Urol

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“…RAE for treatment‐refractory, amyloidosis‐associated nephrotic syndrome has been reported in several case studies since the 1980s . However, these experiences mainly focused on AA‐amyloidosis resulting from underlying inflammatory diseases (Table ) . Reports on RAE use in MGRS‐associated AL‐amyloidosis remain limited, but require particular consideration as they are caused by a malignant B‐cell clone that typically demands intense anti‐tumoral treatment …”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] However, these experiences mainly focused on AA-amyloidosis resulting from underlying inflammatory diseases (Table 1). [14][15][16][17] Reports on RAE use in MGRS-associated AL-amyloidosis remain limited, but require particular consideration as they are caused by a malignant B-cell clone that typically demands intense anti-tumoral treatment. 18 A recent analysis from the Mayo group on a cohort of 66 patients with monoclonal immunoglobulin deposition disease reported that renal response may be observed in…”

Section: Discussionmentioning

confidence: 99%

Kidney embolization induces prompt organ response in a 86‐year‐old patient with MGRS‐related AL‐amyloidosis

Küchlin

Duffner

Scheubeck

et al. 2018

Hemodialysis International

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Despite substantial improvements following the introduction of novel agents and antibodies, amyloid light‐chain (AL)‐amyloidosis still carries a grim prognosis. Here, we report on the case of a severely frail 86‐year‐old patient suffering from monoclonal gammopathy of renal significance (MGRS)‐associated AL‐amyloidosis with a diuretic‐refractory nephrotic syndrome. In this patient, treatment with bortezomib–dexamethasone effectively induced a serological response, but was unfortunately poorly tolerated and failed to promote renal recovery fast enough to prevent secondary complications. Facing ongoing nephrotic syndrome, we performed unilateral kidney embolization and observed a substantial improvement of hypoalbuminemia accompanied by a significant gain in overall quality of life despite the necessity for thrice weekly dialysis. It can be concluded that systemic drugs in MGRS typically do not lead to instantaneous organ recovery but may initially rather be associated with substantial treatment‐related morbidity. In this setting, unilateral renal artery embolization is effective to treat nephrotic syndrome and its secondary complications. The risk of potentially adverse effects, including post‐embolization syndrome, can be minimized by unilateral embolization, still noting that also one‐sided renal ablation has to be balanced against the requirement for life‐long renal replacement therapy. Prospective controlled trials in a more comprehensive cohort will be needed to estimate the overall benefit of kidney embolization relative to novel agent therapies in frail patients with MGRS‐related AL‐amyloidosis.

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Renal artery embolization in severe nephrotic syndrome

Solak

Koç

Uçar

et al. 2016

Hemodialysis International

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Introduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients.

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PERCUTANEOUS TRANSCATHETER RENAL EMBOLIZATION WITH ABSOLUTE ETHANOL FOR UNCONTROLLED NEPHROTIC SYNDROME. Case reports

Abstract: Permanent bilateral ethanol embolization of the renal arteries is a feasible method of managing a treatment-resistant nephrotic syndrome in selected patients. Non-target embolization can be avoided by using a balloon occlusion catheter.

Cited by 5 publications

References 14 publications

Severe Proteinuria Secondary to Amyloidosis Requiring Bilateral Renal Artery Embolization

Severe Proteinuria Secondary to Amyloidosis Requiring Bilateral Renal Artery Embolization

Kidney embolization induces prompt organ response in a 86‐year‐old patient with MGRS‐related AL‐amyloidosis

Renal artery embolization in severe nephrotic syndrome

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