Clinical Profile and Prognostic Outcomes of Adult-Onset Nephrotic Syndrome With Acute Kidney Injury: A Prospective Cohort Study at Bach Mai Hospital

Abstract

Nephrotic syndrome (NS) complicated by acute kidney injury (AKI) is associated with substantial morbidity and an increased risk of long-term renal dysfunction, yet prospective data on histopathological patterns, treatment response, and renal outcomes in this population remain limited. In this prospective observational cohort study, we enrolled 122 adults aged 18–60 years with newly diagnosed NS and concurrent AKI at the Kidney and Urology Center of Bach Mai Hospital, Hanoi, Vietnam, between 2023 and 2024, and followed them for 12 months. Clinical and biochemical parameters, renal biopsy findings, and treatment responses were evaluated, and AKI was classified according to AKIN criteria. Membranous glomerulonephritis (MGN, 36.9%) and focal segmental glomerulosclerosis (FSGS, 35.2%) were the most common histological subtypes, followed by minimal change disease (MCD, 23.0%). Pre-renal AKI accounted for 86.1% of cases, and AKIN Stage I was the most frequent stage at presentation (51.6%). Over 12 months, significant improvements were observed in serum creatinine, uric acid, lipid profile, proteinuria, and hematuria, with serum creatinine decreasing from 1.68 to 1.26 mg/dL and proteinuria from 5.16 to 1.7 g/24 h (p < 0.001 for all). Renal recovery was most frequent in patients with AKIN Stage I (95.2%) and least frequent in those with Stage III disease (30.0%). Treatment response also varied markedly by histological subtype: complete remission occurred in all patients with MCD, in 55.8% of those with FSGS, and in none of those with MGN. These findings indicate that histopathological subtype and AKIN stage are important predictors of renal recovery and therapeutic response in adults with NS-associated AKI, and support the clinical value of early recognition of pre-renal causes together with biopsy-guided management to improve outcomes.