Acute tubular necrosis overview: Difference between revisions
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==Causes== | ==Causes== | ||
Acute tubular necrosis is commonly caused by [[Kidney|renal]] [[ischemia]] resulting from conditions such as [[Hypovolemia|volume depletion]], [[hypotension]], [[Sepsis|septic shock]], [[cirrhosis]], and [[Disseminated intravascular coagulation|DIC]]. It is also caused by exposure to various nephrotoxic medications including [[Aminoglycoside|aminoglycosides]], [[amphotericin B]], [[ACE inhibitor|ACE inhibitors]], [[Non-steroidal anti-inflammatory drug|NSAIDs]], antiviral drugs, [[Chemotherapy|cytotoxic therapy]],and also exposure to [[Contrast media|radio contrast substances]]. | |||
==Differentiating Xyz from Other Diseases== | ==Differentiating Xyz from Other Diseases== | ||
Revision as of 18:58, 29 May 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
Acute tubular necrosis (ATN) defines a pathologic process rather than a clinical syndrome in which varying degrees of renal tubular injury occur. Clinically, ATN manifests as acute kidney injury although the terms have previously been used interchangeably. ATN is the most common cause of overt AKI. Despite the term, ATN does not necessarily imply cellular necrosis with evidence of non-necrotic injury observed more consistently. Furthermore, clinicopathologic correlation is often irrelevant with severe renal insufficiency sometimes seen with modest pathological findings.[1] ATN can be either ischemic or toxin induced. Classically, ischemic ATN follows hypotension or hypovolemia with patchy involvement usually observed. On the other hand, toxic ATN is usually a dose-dependent injury seen with medications, diagnostic agents, and heavy metals with proximal tubule damage involving almost all nephrons.[2]
Historical Perspective
Classification
Acute tubular necrosis may be classified based on mechanisms of tubular injury into three categories ischemic, toxin-induced, and mixed.
Pathophysiology
Causes
Acute tubular necrosis is commonly caused by renal ischemia resulting from conditions such as volume depletion, hypotension, septic shock, cirrhosis, and DIC. It is also caused by exposure to various nephrotoxic medications including aminoglycosides, amphotericin B, ACE inhibitors, NSAIDs, antiviral drugs, cytotoxic therapy,and also exposure to radio contrast substances.
Differentiating Xyz from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Rosen S, Stillman IE (2008). "Acute tubular necrosis is a syndrome of physiologic and pathologic dissociation". J Am Soc Nephrol. 19 (5): 871–5. doi:10.1681/ASN.2007080913. PMID 18235086.
- ↑ Fogo A, Cohen AH, Colvin RB et al. Fundamentals of Renal Pathology. Springer 2013. Acute Tubular Necrosis. http://dx.doi.org/10.1007/978-3-642-39080-7_15