MON-023 HYPOKALEMIC NEPHROPATHY IN NEPHROTIC SYNDROME PATIENT

Abstract

Hypokalemic nephropathy (HN) caused by prolonged K+ deficiency is associated with metabolic alkalosis, polydipsia, polyuria, growth retardation, hypertension, and progressive tubulointerstitial injury. Histopahologic report of HN in nephrotic syndrome (NS) patient is rare. A 27 year male suffered from weakness, especially lower leg, since two weeks prior to admission. The patients had a history of NS since childhood and cared by nephrologist. Recent condition was hemodynamically stable, laboratory examination showed potassium serum 1.85 mmol/L, albumin plasma 1.8 g/dL, serum creatinine 2.45 mg/dL, and marked dyslipidemia. The patient was clinically assesed with hypokalemia, relapse nephrotic syndrome and renal insufficiency. Intravenous potassium was given and renal biopsy was performed. Histopathologic findings showed global sclerosis. The specific findings may related to HN were mesangial proliferation and specific lesions on tubules including athrophy, vacuolization, intratubular deposition of amorphous and laminated hyaline materials and colloidisation of tubular epithelial, and interstitial nephritis. The patient was discharged at 10th day of hospitalization with potassium level 2.93 mmol/L, and serum creatinine 1.95 mg/dL. The patient was treated with oral methylprednisolone, mychophenolate mofetil, ACE-inhibitor, simvastatin and oral potassium Hypokalemic nephropathy may associate with chronic hypokalemia. Hypokalemia, especially if persistently occurs, can induce a variety of changes in renal tissue, impairing tubular transport and possibly inducing chronic tubulointerstitial disease and cyst formation. HN also associated with alterations in intrarenal vasoactive substances, leading to vasoconstriction, salt-sensitivity, and progression of interstitial fibrosis. Histopathological changes in HN, including severe tubular dilatation, intratubular deposition of amorphous and laminated hyaline materials, intratubular cellular casts, and tubular atrophy is found. More attention is paid to athrophy and vacuolar changes in renal tubular epithelium accompanied by inflammatory interstitial changes in patients with potassium losses. One function that is not impaired is the ability to appropriately conserve potassium, which can be important in distinguishing between extrarenal and renal sources of potassium losses when the cause of hypokalemia is not clear.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) A case with nephrotic syndrome associated with HN is reported. Chronic hypokalemia may involve in the development of hypokalemic nephropathy. Hallmark of histopathologic finding are tubular epithel athrophy, intratubular amorphous deposition and vacuolization of tubular cells, and interstitial nephritis to fibrosis.