Acute tubular necrosis: Difference between revisions

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{{Infobox_Disease |
{{Acute tubular necrosis}}
  Name          = Acute tubular necrosis |
{{CMG}}; {{AE}} {{CK}}
  Image          = Acute tubular necrosis.jpg|
  Caption        = Acute Tubular Necrosis: Gross, good example of bilateral cortical necrosis and uterus with hemorrhage (secondary to abortion). <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small> |
  DiseasesDB    = 11263 |
  ICD10          = {{ICD10|N|17|0|n|17}} |
  ICD9          = {{ICD9|584.5}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 39 |
  eMedicine_mult = {{eMedicine2|ped|28}} |
  MeshID        = D007683 |
}}
{{Acute tubular necrosis (patient information)}}
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{Editor Join}}
{{SK}} ATN


==Overview==
==[[Acute tubular necrosis overview|Overview]]==


'''Acute tubular necrosis''' or ('''ATN''') is a medical condition involving the death of tubular cells that form the [[tubule]] that transports [[urine]] to the [[ureter]]s while reabsorbing 99% of the water (and highly concentrating the salts and metabolic byproducts).  Tubular cells continually replace themselves and if the cause of Acute Tubular Necrosis is removed then recovery is likely. ATN presents with [[acute renal failure]] and is one of the most common causes of ARF.  The presence of "muddy brown casts" of epithelial cells found in the urine during urinalysis is pathognomonic for Acute Tubular Necrosis.
==[[Acute tubular necrosis classification|Classification]]==


It may be classified as either ''toxic'' or ''[[Ischemia|ischemic]]''. Toxic Acute Tubular Necrosis occurs when the tubular cells are exposed to a toxic substance ([[nephrotoxic]] Acute Tubular Necrosis). Ischemic Acute Tubular Necrosis occurs when the tubular cells do not get enough oxygen, a condition they are highly sensitive to due to their very high [[metabolism]].
==[[Acute tubular necrosis pathophysiology|Pathophysiology]]==


==Toxic Acute Tubular Necrosis ==
==[[Acute tubular necrosis causes|Causes]]==
Toxic ATN can be caused by free [[hemoglobin]] or [[myoglobin]], by medication such as [[antibiotic]]s and cytostatic drugs, 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]], obliterating it, and determining acute renal failure. Basement membrane is intact, so the tubular epithelium regeneration is possible. Glomeruli are not affected.
==[[Acute tubular necrosis epidemiology and demographics|Epidemiology and Demographics]]==


==Ischemic Acute Tubular Necrosis==
==[[Acute tubular necrosis risk factors|Risk Factors]]==
Ischemic Acute Tubular Necrosis can be caused when the [[kidneys]] are not sufficiently perfused for a long period of time (i.e. [[renal artery stenosis]]) or during [[Shock (medical)|shock]]. [[Hypoperfusion]] can also be caused by [[embolism]] of the renal arteries.
Ischemic Acute Tubular Necrosis specifically causes ''skip lesions'' through the tubules.


==Pathology==
==[[Acute tubular necrosis differential diagnosis|Differentiating Acute tubular necrosis from other Diseases]]==
===Acute tubular necrosis from ethylene glycol===


<youtube v=mqXx2EMTgec/>
==[[Acute tubular necrosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
==Diagnosis==
[[Acute tubular necrosis history and symptoms|History and Symptoms]] | [[Acute tubular necrosis physical examination|Physical Examination]] | [[Acute tubular necrosis laboratory findings|Laboratory Findings]] | [[Acute tubular necrosis CT|CT]] | [[Acute tubular necrosis MRI|MRI]] | [[Acute tubular necrosis echocardiography or ultrasound|Ultrasound]] | [[Acute tubular necrosis other imaging findings|Other Imaging Findings]] | [[Acute tubular necrosis other diagnostic studies|Other Diagnostic Studies]]
 
==Treatment==
[[Acute tubular necrosis medical therapy|Medical Therapy]] | [[Acute tubular necrosis primary prevention|Primary Prevention]] | [[Acute tubular necrosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Acute tubular necrosis future or investigational therapies|Future or Investigational Therapies]]
 
==Case Studies==
[[Acute tubular necrosis case study one|Case#1]]


==External links==
==External links==
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Latest revision as of 18:32, 29 May 2018

Acute tubular necrosis Microchapters

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

For patient information click here

Synonyms and keywords: ATN

Overview

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Differentiating Acute tubular necrosis from other Diseases

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

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Acute Tubular Necrosis

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