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NDT Plus Advance Access originally published online on February 16, 2009
NDT Plus 2009 2(3):228-232; doi:10.1093/ndtplus/sfp019
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Remission of membranoproliferative glomerulonephritis associated with a noncirrhotic portosystemic shunt after percutaneous transhepatic portal vein embolization

Nobuhiko Okamoto1, Sawako Fukazawa1, Masafumi Shimamoto1, Rie Yamamoto1 and Yuichiro Fukazawa2

1 Department of Nephrology, Nippon Telegraph and Telephone East Corporation Sapporo Hospital
2 Department of Pathology, KKR Sapporo Medical Center, Sapporo 062-0931, Japan

Correspondence: Correspondence and offprint requests to: Nobuhiko Okamoto, Department of Nephrology, Nippon Telegraph and Telephone East Corporation Sapporo Hospital, South 1 West 15, Chuou-ku Sapporo 060-0061, Japan. Tel: +81-11-623-8400; Fax: +81-11-623-8407; E-mail: nobuhiko_okamoto{at}east.ntt.co.jp


  Abstract

We present a case of a 75-year-old man with nephrotic syndrome and renal insufficiency caused by immune complex-mediated secondary membranoproliferative glomerulonephritis. He developed hepatic encephalopathy. A congenital portosystemic shunt was identified, indicating a diagnosis of membranoproliferative glomerulonephritis with noncirrhotic portosystemic shunt. Proteinuria resolved after shunt ratio reduction by percutaneous transhepatic portal vein embolization. Renal function and histopathological findings improved without immunosuppressive therapy. This case emphasizes the role of a high shunt ratio and reduced hepatic clearance of circulating immune complexes in such nephropathy. Membranoproliferative glomerulonephritis with a shunt may cause refractory nephrotic syndrome, but embolization is effective.

Key Words: cirrhosis-associated IgA nephropathy • membranoproliferative glomerulonephritis • noncirrhotic portosystemic shunt • percutaneous transhepatic portal vein embolization

Received for publication October 16, 2008. Accepted for publication January 29, 2009.


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