Experience with Medical Nephrectomy

Abstract

In the past, patients with nephrotic syndrome have died from severe proteinuria, hypoproteinemia, anasarca, malnutrition, infection, and end-stage renal disease. The development and effective use of more potent diuretics and antibiotics have improved management of these patients, and treatment by dialysis has prevented death when nephrotic syndrome has gone on to end-stage renal failure and uremia. This prevention of death from renal failure and uremia in these patients has also suggested that, if the degree of proteinuria, edema, and malnutrition were life threatening, the patient′s life might be saved by altering renal function to decrease proteinuria and then maintaining the patient, if necessary, by chronic dialysis. Reports of ablation of renal function for this purpose have described a number of techniques, including surgical nephrectomy and complete infarction of both kidneys by embolization^1,2 as well as decrease of proteinuria produced either by prostaglandin synthetase inhibitors^3–5 or by administration of metallic salts.^6,7