Acute tubular necrosis history and symptoms
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History taking is an important aspect in making a diagnosis of acute tubular necrosis. It provides clues to precipitating factors, causes and associated comorbid conditions leading to decreased renal perfusion and kidney injury. Most common symptoms of acute tubular necrosis include decreased or absent urinary output, postural dizziness, edema, excess thirst, tachycardia, altered mental status and easy fatiguability.
Obtaining history is the most important aspect of making a diagnosis of acute tubular necrosis. It provides insight into the cause, precipitating factors, and associated comorbid conditions leading to decreased renal blood flow and acute tubular damage. A complete history will help determine the correct therapy and the prognosis. Specific areas of focus when obtaining the history are outlined below:
- History of recent surgery
- Sepsis / septic shock
- Profound hypotension
- Severe volume loss (eg, diarrhea, vomiting, bleeding and third-spacing)
- Medication history (eg, exposure to nephrotoxic drugs and radiocontrast substances)
- Tissue injury involving muscles (eg, crush injury, burns, rhabdomyolysis)
- Blood transfusion reaction
- Associated conditions: History of pre-existing medical conditions such as multiple myeloma and diabetes mellitus may cause a decreased renal function
- Decreased or absent urine output
- Dark colored urine
- Excessive thirst
- Generalised edema
- Postural dizziness
- Rapid pulses
- Muscle cramps
- Altered mental status
- Stupor or coma
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