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==Overview==
==Overview==
==Pathophysiology==
==Pathophysiology==
==Toxic Acute Tubular Necrosis ==
===Toxic Acute Tubular Necrosis ===
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").
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").


==Ischemic Acute Tubular Necrosis==
===Ischemic Acute Tubular Necrosis===
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 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.
Ischemic Acute Tubular Necrosis specifically causes ''skip lesions'' through the tubules.

Revision as of 01:43, 1 October 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pathophysiology

Toxic Acute Tubular Necrosis

Toxic ATN can be caused by free hemoglobin or myoglobin, by medication such as antibiotics and cytostatic drugs, or by intoxication (ethylene glycol, "anti-freeze").

Ischemic Acute Tubular Necrosis

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. Hypoperfusion can also be caused by embolism of the renal arteries. Ischemic Acute Tubular Necrosis specifically causes skip lesions through the tubules.

Microscopic Pathology

Acute tubular necrosis from ethylene glycol

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.

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