Did Mozart Die of Kidney Disease?

What's a picture of Mozart doing on the Renal Fellow Network?

Fellow renal fellow Lisa Cohen gave a presentation on nephrotic syndrome at our Renal Grand Rounds and discussed evidence that Mozart, who died at the young age of 35, also had nephrotic syndrome. Consistent amongst the impressive literature trying to determine the cause of the young composer's death are reports of his having massive anasarca at the time of his death. While there are certainly multiple etiologies of anasarca, the fact that he was allegedly able to sing lines from his famous "Requiem" on his deathbed suggests that he was neither encephalopathic nor dyspneic, favoring a renal cause of anasarca rather than a hepatic or cardiac one.

Theories of what caused his fatal illness are broad: suggested possibilities include post-streptococcal glomerulonephritis (he apparently had a serious febrile illness as a child), a congenital urinary tract malformation (he had a history of recurrent UTIs and also had an ear malformation--sometimes associated with congenital renal anomalies), Henoch-Schonlein purpura (he had a concurrent rash during his fatal illness), renal tuberculosis (T.B. was a major cause of disease in this era, both pulmonary and otherwise), heavy metal poisoning (there are rumors that his competitor Salieri once admitted to poisoning Mozart out of jealousy), and other primary nephrotic syndromes. Obviously this differential diagnosis is broad and we are unlikely to answer this question definitively, but it is tempting to speculate not only on the nature of his disease, but also on the further musical works he might have written had he been born in the modern era of kidney-aiding medications and renal replacement therapies.

This post is complementary to a previous posting on this blog regarding famous individuals with nephrotic syndrome.