Acute tubular necrosis

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Acute tubular necrosis
SpecialtyNephrology

Acute tubular necrosis (ATN) is a medical condition involving the

hydration and cessation of the offending drug). Because the tubular cells continually replace themselves, the overall prognosis for ATN is quite good if the underlying cause is corrected, and recovery is likely within 7 to 21 days.[2]

Classification

ATN may be classified as either

nephrotoxic ATN). Ischemic ATN occurs when the tubular cells do not get enough oxygen, a condition that they are highly sensitive and susceptible to, due to their very high metabolism.[4]
Due to several reasons, the proximal portion of the renal tubule is most commonly injured in ATN.

Diagnosis

Acute tubular necrosis is classified as a "renal" (i.e. not pre-renal or post-renal) cause of acute kidney injury. Diagnosis is made by a FENa (

granular cast) in urinalysis. On histopathology, there is usually tubulorrhexis, that is, localized necrosis of the epithelial lining in renal tubules, with focal rupture or loss of basement membrane.[5] Proximal tubule cells can shed with variable viability and not be purely "necrotic".[6][7][8][9][10]

Toxic ATN

Toxic ATN can be caused by free

cytotoxic drugs such as cisplatin, or by intoxication (ethylene glycol
, "anti-freeze").

Histopathology: Toxic ATN is characterized by proximal tubular epithelium necrosis (no nuclei, intense eosinophilic homogeneous cytoplasm, but preserved shape) due to a toxic substance (poisons, organic solvents, drugs, heavy metals). Necrotic cells fall into the tubule lumen, obturating it, and determining acute kidney failure. Basement membrane is intact,[citation needed] so the tubular epithelium regeneration is possible. Glomeruli are not affected.[2]

Ischemic ATN

Ischemic ATN can be caused when the

Hypoperfusion can also be caused by embolism of the renal arteries. Given their importance in massive nutrient and electrolyte reabsorption, the proximal tubule and medullary thick ascending limb require significant ATP and are most susceptible to ischemic damage. Thus, ischemic ATN specifically causes skip lesions through the tubules.[3]

See also

References

  1. ^ Desanti De Oliveira, B., Xu, K., Shen, T.H. et al. Molecular nephrology: types of acute tubular injury. Nat Rev Nephrol 15, 599–612 (2019). https://doi.org/10.1038/s41581-019-0184-x
  2. ^ a b c d "Acute Tubular Necrosis (ATN)". Nephrology Channel. HealthCommunities.com. 2008. Retrieved 2008-09-23.
  3. ^
    OCLC 191854838
    .
  4. OCLC 191854838.[page needed
    ]
  5. ^ TheFreeDictionary > tubulorrhexis Citing: The American Heritage Medical Dictionary 2007
  6. PMID 11675413
    .
  7. PMID 10354308
    .
  8. S2CID 39727538
    .
  9. PMID 8510383
    .
  10. PMID 1673163
    .
  11. PMID 2650018
    .
  12. PMID 12778436
    .

External links

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