Reversible acute renal failure from gross haematuria due to glomerulonephritis: not only in IgA nephropathy and not associated with intratubular obstruction

Seven patients with acute renal failure due to gross haematuriacaused by glomerulonephritis are described. Gross haematurialasting 4–40 days led to acute impairment of renal functionof variable severity (peak plasma creatinine 1.3–12 mg/dl)and duration. While partial recovery of renal function occurredin all patients within few days, complete remission was observedonly some months later. Three patients had IgA nephropathy (2the primary form and 1 nephritis secondary to Schönlein-Henochpurpura), two patients had acute postinfectious glomerulonephritis,andtwo others had focal necrotizing (pauci-immune) glomerulonephritis.The glomerular changes seen in renal biopsy were not enoughto explain per se the renal function impairment. Tubular changes,however, were severe and consisted of tubular necrosis, erythrocytecasts, erythrocyte phagocytosis by tubular cells, accompaniedby interstitial damage (oedema, red-cell extravasation, andinflammatory infiltrates). Study of the renal biopsies by immunofluorescencerevealed retrodiffusion of Tamm-Horsfall protein into the glomerularBowman’s space, a sign of obstructed tubular flow in anycase. It is concluded that acute renal failure due to grosshaematuria in glomerulonephritic patients may not occur onlyin IgA nephropathy, as reported so far, and is not associatedwith intratubular obstruction.