Acute tubular necrosis other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]


Renal biopsy and detection of various novel biomarkers in the serum and urine can be helpful in diagnosing acute tubular necrosis.

Other Diagnostic Studies

  • Renal biopsy: Finding of acute tubular necrosis on renal biopsy may include:[1]
    • Tubular dilatation and swollen tubular cells
    • Loss of tubular cells or the denuded tubules
    • Thinning of the tubular epithelium
    • Loss of the cell brush border
    • Edema of the interstitium
    • Presence of cellular casts
  • Novel biomarkers: Evaluation of various urinary and serum biomarkers may be helpful in patients with acute tubular necrosis to identify renal tubular injury at the very early stage.[2][3][4][5]
BIomarker Finding
Neutrophil gelatinase-associated lipocalin (NGAL)  Elevated levels are found in urine following tubular injury
Interleukin-18 (IL-18) Elevated levels of IL-18 are found in urine after renal tubular injury.
Kidney Injury Molecule-1 (KIM-1) Produced by proximal tubular cells after ischaemic or nephrotoxic injury. Elevated levels are found in urine following tubular injury
Cystatin C Cysteine protease inhibitor filtered at the glomerulus and reabsorbed at the proximal tubule without secretion. Elevated levels in urine may be found after tubular insult.
Liver-type fatty acid binding protein (L-FABP) Produced in proximal tubular cells and in the liver. Elevated levels are found in urine following tubular injury.
Tubular enzymes: Alpha glutathione S-transferase,  pi-glutathione S-transferase, N-acetyl-beta-glucosaminidase Tubular enzymes are elevated in urine following renal tubular injury
Retinol binding protein (RBP) Produced by the liver and completely filtered by glomeruli and reabsorbed, bot secreted by proximal tubular cells. It is released into urine following injury involving renal tubules.
Alpha 1 microglobulin, Beta 2 microglobulin Both are released in urine after renal tubular injury
Netrin-1 Increased expression can be found in damaged tubular cells and elevated levels are found in urine.


  1. Tavares MB, Chagas de Almeida Mda C, Martins RT, de Sousa AC, Martinelli R, dos-Santos WL (2012). "Acute tubular necrosis and renal failure in patients with glomerular disease". Ren Fail. 34 (10): 1252–7. doi:10.3109/0886022X.2012.723582. PMC 3496189. PMID 23002699.
  2. Ostermann M, Joannidis M (September 2016). "Acute kidney injury 2016: diagnosis and diagnostic workup". Crit Care. 20 (1): 299. doi:10.1186/s13054-016-1478-z. PMC 5037640. PMID 27670788.
  3. Herget-Rosenthal S (2005). "One step forward in the early detection of acute renal failure". Lancet. 365 (9466): 1205–6. doi:10.1016/S0140-6736(05)74787-5. PMID 15811437.
  4. Zhou H, Hewitt SM, Yuen PS, Star RA (March 2006). "Acute Kidney Injury Biomarkers - Needs, Present Status, and Future Promise". Nephrol Self Assess Program. 5 (2): 63–71. PMC 2603572. PMID 19096722.
  5. Parikh CR, Abraham E, Ancukiewicz M, Edelstein CL (October 2005). "Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit". J. Am. Soc. Nephrol. 16 (10): 3046–52. doi:10.1681/ASN.2005030236. PMID 16148039.

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