Acute Tubular Necrosis

 

 

 

Causes and Risk Factors

 

Results from a massive insult.

Nephrotoxic

ischemic, either hemodynamic or shock

 

 

 

 

 

Signs, Symptoms, and Diagnosis

 

  • history
  • physical exam
  • lab investigations
  • diagnostic imaging

History

Physical Exam

Lab Investigations

 

Progressive rate of rise of sCr

metabolic acidosis, hyperkalemia, hypocalcemia, inc or dec phos

granular or epithelial casts

FeNa >2, UNa >40 mmol/L

Diagnostic Imaging

 

 

 

 

 

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Pathophysiology

 

Tubule cells die for various reasons, then slough off. The resulting casts can cause obstructions.

Ischemia

endo- and exotoxins

 

 

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Treatments

 

Prevention

Identify pts at risk

volume status

avoid nephrotoxins

caution with diuretics

rhabdomyolisis/hemolysis

uric acid: allopurinol, HCO3

contrast: prehydration, mucomyst

 

 

 

 

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Consequences and Course

50% mortality

Oliguric 1-16 weeks, avg 1-2 weeks

diuretic 1-2 weeks

recovery 3-12 months

 

 

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The Patient

 

 

 

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Health Care Team

 

 

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Community Involvement

 

 

 

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Resources and References