Therapeutic Renal Arterial Occlusion for Elimination of Proteinuria

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Abstract
Excessive renal protein losses in patients with the nephrotic syndrome may lead to malnutrition, debility, and, ultimately, to death. We describe a patient with severe nephrotic syndrome complicated by multiple thrombotic and infectious morbid events. The patient's poor general condition precluded safe surgical removal of the kidneys. In order to terminate protein loss, bilateral "medical nephrectomy" was done by occluding the renal arteries with selective injections of isobutyl 2-cyanoacrylate. PATIENT SUMMARY A 35-year-old woman developed proteinuria, hypertension, and edema in May 1968. Daily urinary protein losses ranged from 12 to 14 gm. A renal biopsy specimen showed idiopathic membranous glomerulonephritis. The creatinine clearance was 30 ml/min. Platelet counts were consistently 600,000 to 1,000,000/cu cm and her serum cholesterol value was 600 mg/100 ml. She was treated with prednisone and azathioprine for two years without improvement in her proteinuria, thrombocytosis, or hypercholesterolemia. In November 1968, she suffered a spontaneous thrombosis of

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