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Several cases of acute renal failure associated with episodes of macroscopic hematuria (EMH) in IgA nephropathy (IgAN) have been reported; in every case renal function returned to normal. We report 2 cases with previous normal renal function that developed acute renal failure during EMH of 17 and 30 days duration, respectively. Renal biopsies showed mesangial proliferation with IgA deposits, crescents in 10-15% of glomeruli and a marked tubular necrosis with red blood cell casts obstructing the lumen in 30-45% of tubules. Although renal function improved after EMH cessation, it did not recover previous normal values. Thus, EMH can produce permanent loss of renal function in patients with IgAN.
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