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{{Acute tubular necrosis}}
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==Overview==
[[Complete blood count|CBC]], [[urinalysis]] with sediment [[microscopy]], [[urine]] electrolytes, [[osmolarity]], serum electrolytes, [[blood urea nitrogen]] and [[Creatinine|serum creatinine]], and [[Dipsticks|urine dipstick]] are commonly performed in patients to evaluate acute tubular necrosis and other causes of [[Acute kidney injury|acute renal failure]]. [[Urine]] sediment may show tubular epithelial cells and epithelial cell casts or brown muddy granular [[casts]]. Increased urine [[sodium]] concentration >40 mEq/L, urine [[Fractional sodium excretion|fractional excretion of sodium]] greater than 2 percent along with elevated serum [[creatinine]] concentration at a rate greater than 0.3 mg/dL/day may be found in [[acute tubular necrosis]]. However, these tests may have some limitations.
 
==Laboratory Findings==
[[Patient|Patients]] with acute tubular necrosis may show following findings on [[Medical laboratory|laboratory]] tests. These include:
* [[Complete blood count]] ([[Complete blood count|CBC]]):
** [[Anemia|Anaemia]] may be  due to decreased [[erythropoietin]] production.
** Abnormal [[Platelet|platelets]]
* [[Urinalysis]]:<ref name="pmid27670788">{{cite journal |vauthors=Ostermann M, Joannidis M |title=Acute kidney injury 2016: diagnosis and diagnostic workup |journal=Crit Care |volume=20 |issue=1 |pages=299 |date=September 2016 |pmid=27670788 |pmc=5037640 |doi=10.1186/s13054-016-1478-z |url=}}</ref><ref name="pmid19921458">{{cite journal |vauthors=Kanbay M, Kasapoglu B, Perazella MA |title=Acute tubular necrosis and pre-renal acute kidney injury: utility of urine microscopy in their evaluation- a systematic review |journal=Int Urol Nephrol |volume=42 |issue=2 |pages=425–33 |date=June 2010 |pmid=19921458 |doi=10.1007/s11255-009-9673-3 |url=}}</ref>
** [[Urine]] sediment [[microscopy]] may show muddy brown granular casts from necrotic tubular cells binds with tamm horsfall protein or epithelial cell casts, and renal tubular epithelial cells. Acute tubular necrosis caused by [[rhabdomyolysis]] and [[hemolysis]], [[urinalysis]] may show heme-positive urine with out [[Red blood cell|erythrocytes]].
** [[Urine]] [[sodium]] concentration:<ref name="pmid666184">{{cite journal |vauthors=Miller TR, Anderson RJ, Linas SL, Henrich WL, Berns AS, Gabow PA, Schrier RW |title=Urinary diagnostic indices in acute renal failure: a prospective study |journal=Ann. Intern. Med. |volume=89 |issue=1 |pages=47–50 |date=July 1978 |pmid=666184 |doi= |url=}}</ref> Urine sodium concentration is high >40 mEq/L
** [[Urine]] [[Fractional sodium excretion|fractional excretion of sodium]] concentration:<ref name="pmid6486145">{{cite journal |vauthors=Steiner RW |title=Interpreting the fractional excretion of sodium |journal=Am. J. Med. |volume=77 |issue=4 |pages=699–702 |date=October 1984 |pmid=6486145 |doi= |url=}}</ref> > 2%
*** Limitations of the [[Fractional sodium excretion|fractional excretion of sodium]] percent: Some conditions include, [[Contrast media|radio contrast media]] induced nephropathy, acute tubular necrosis in the presence of cirrhosis and congestive heart failure, and rhabdomyolysis may have <1%.
** [[Urine]] [[osmolarity]]:<ref name="pmid666184">{{cite journal |vauthors=Miller TR, Anderson RJ, Linas SL, Henrich WL, Berns AS, Gabow PA, Schrier RW |title=Urinary diagnostic indices in acute renal failure: a prospective study |journal=Ann. Intern. Med. |volume=89 |issue=1 |pages=47–50 |date=July 1978 |pmid=666184 |doi= |url=}}</ref> <350 mosmol/kg
* Serum [[Electrolyte disturbance|electrolyte abnormalities]]: [[Hyperkalemia]], [[hyperphosphatemia]], [[hyponatremia]], [[hypocalcemia]], and [[hypomagnesemia]] may be found.<ref name="pmid27267762">{{cite journal |vauthors=Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O |title=Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke |journal=BMC Nephrol |volume=17 |issue=1 |pages=55 |date=June 2016 |pmid=27267762 |pmc=4895821 |doi=10.1186/s12882-016-0268-9 |url=}}</ref>
* Urine/plasma [[creatinine]] ratio: <20<ref name="pmid666184">{{cite journal |vauthors=Miller TR, Anderson RJ, Linas SL, Henrich WL, Berns AS, Gabow PA, Schrier RW |title=Urinary diagnostic indices in acute renal failure: a prospective study |journal=Ann. Intern. Med. |volume=89 |issue=1 |pages=47–50 |date=July 1978 |pmid=666184 |doi= |url=}}</ref>
* Fractional excretion of urea: >35%
* Urine/plasma urea nitrogen:<3
* Ratio of [[Blood urea nitrogen|BUN]]/[[Creatinine|sr.creatinine]]: 10 to 15:1 and is normal.
* Rate of [[creatinine]] concentration in serum rise: Serum [[creatinine]] levels are increased progressively at a rate greater than 0.3 to 0.5 mg/dL/day.
* [[Specific gravity]]: Low <1.020
* [[Urine]] [[Dipsticks|dipstick]] test: Commonly performed for [[blood]] pigments, [[Protein|proteins]], [[White blood cells|WBC]], [[Nitrite|nitrites]], and [[glucose]] in all patients with suspected [[Renal insufficiency|renal failure]] to exclude certain [[Etiology|etiologies]] such as [[infection]], [[hemolysis]], [[myoglobinuria]], and [[rhabdomyolysis]].
{| class="wikitable"
!Test
!Findings
|-
|[[Urine]] sediment [[microscopy]]
|Muddy brown granular casts and epithelial cell casts
|-
|[[Urine]] [[sodium]]
|>40 mEq/L
|-
|[[Fractional sodium excretion|Fractional excretion of sodium]]
|> 2%
|-
|[[Urine]] [[osmolarity]]
|<350 mosmol/kg
|-
|Serum [[creatinine]]
|Elevated
|-
|[[Blood urea nitrogen|BUN]]
|Elevated
|-
|Urine/plasma [[creatinine]] ratio
|<20
|-
|Ratio of [[Blood urea nitrogen|BUN]]/[[Creatinine|sr.creatinine]]
|10 to 15:1
|-
|Urine/plasma urea nitrogen
|<3
|-
|Serum electrolytes
|[[Hyperkalemia]] (↑[[Potassium|K]])
[[Hyperphosphatemia]] (↑[[Phosphate|P]])
 
[[Hyponatremia]] (↓[[Sodium|Na]])
 
[[Hypocalcemia]] (↓[[Calcium|Ca]])
 
[[Hypermagnesemia]] (↑[[Magnesium|Mg]])
 
|}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
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Latest revision as of 19:20, 15 June 2018

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

Overview

CBC, urinalysis with sediment microscopy, urine electrolytes, osmolarity, serum electrolytes, blood urea nitrogen and serum creatinine, and urine dipstick are commonly performed in patients to evaluate acute tubular necrosis and other causes of acute renal failure. Urine sediment may show tubular epithelial cells and epithelial cell casts or brown muddy granular casts. Increased urine sodium concentration >40 mEq/L, urine fractional excretion of sodium greater than 2 percent along with elevated serum creatinine concentration at a rate greater than 0.3 mg/dL/day may be found in acute tubular necrosis. However, these tests may have some limitations.

Laboratory Findings

Patients with acute tubular necrosis may show following findings on laboratory tests. These include:

Test Findings
Urine sediment microscopy Muddy brown granular casts and epithelial cell casts
Urine sodium >40 mEq/L
Fractional excretion of sodium > 2%
Urine osmolarity <350 mosmol/kg
Serum creatinine Elevated
BUN Elevated
Urine/plasma creatinine ratio <20
Ratio of BUN/sr.creatinine 10 to 15:1
Urine/plasma urea nitrogen <3
Serum electrolytes Hyperkalemia (↑K)

Hyperphosphatemia (↑P)

Hyponatremia (↓Na)

Hypocalcemia (↓Ca)

Hypermagnesemia (↑Mg)

References

  1. ↑ 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.
  2. ↑ Kanbay M, Kasapoglu B, Perazella MA (June 2010). "Acute tubular necrosis and pre-renal acute kidney injury: utility of urine microscopy in their evaluation- a systematic review". Int Urol Nephrol. 42 (2): 425–33. doi:10.1007/s11255-009-9673-3. PMID 19921458.
  3. ↑ 3.0 3.1 3.2 Miller TR, Anderson RJ, Linas SL, Henrich WL, Berns AS, Gabow PA, Schrier RW (July 1978). "Urinary diagnostic indices in acute renal failure: a prospective study". Ann. Intern. Med. 89 (1): 47–50. PMID 666184.
  4. ↑ Steiner RW (October 1984). "Interpreting the fractional excretion of sodium". Am. J. Med. 77 (4): 699–702. PMID 6486145.
  5. ↑ Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O (June 2016). "Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke". BMC Nephrol. 17 (1): 55. doi:10.1186/s12882-016-0268-9. PMC 4895821. PMID 27267762.

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