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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Necrotizing fasciitis can present with concomitant acute kidney injury. The etiology of acute kidney injury is often multifactorial; potential sources include volume depletion, abdominal compartment syndrome, rhabdomyolysis, and acute tubular necrosis (which may be related to hemodynamic instability, medications, or sepsis/infection). Kidney injury, defined via changes in serum creatinine, portends increased morbidity and mortality. Thus, it is crucial to accurately diagnose and assess the severity of kidney injury. We present the case of a patient with necrotizing fasciitis who endured 31 consecutive days of complete anuria. His serum creatinine decreased over this interval without the use of extracorporeal hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume resuscitation. The patient's own convective clearance was substantial enough to maintain a modest creatinine clearance of 15 ml/min during sustained anuria. Our case emphasizes the importance of employing the creatinine, estimated glomerular filtration rate, and urine output portions of the Acute Kidney Injury Network (AKIN) or Risk Injury Failure Loss End stage (RIFLE) criteria in assessing the severity of kidney injury. It further reinforces the imperfection in using serum creatinine as a primary measure of glomerular filtration rate.
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PMID:Autologous creatinine clearance in a case of necrotizing fasciitis and anuria. 2234 4

Reflex anuria (RA) was defined by Hull as cessation of urine output from both kidneys due to irritation or trauma to one kidney or its ureter, or severely painful stimuli to other organs. This is not a common concept among urologists or nephrologists even though it has been proposed for more than half a century. The phenomenon has not been thoroughly understood. But intrarenal arteriolar spasm and ureteral spasm have gained wide acceptance as the mechanisms of RA. The present review summarized papers published up to now on RA, in order to depict the general profile of the disease and to further elucidate the pathogenesis of RA. A classification system of RA was proposed as neurovascular reflex, ureterorenal reflex, radiated renovascular reflex, renoureteral reflex, ureteroureteral reflex and radiated ureteral reflex, based on the two assumed mechanisms and the stimulus' origins. All these types except renoureteral reflex had gained supporting evidence from animal experiments and/or clinical case reports. RA is a diagnosis of exclusion, only being considered after ruling out common and tangible etiologies such as ureteral calculi, acute tubular necrosis, renal vascular occlusion, hypovolemia, infection, etc. If the diagnosis has been established, treatment plan should be directed toward the mechanisms more than the causative factors. Abnormalities of the autonomic nerve system and congenital urogenital malformations incline people to RA. In summary, RA is a cessation of urine production caused by stimuli on kidney, ureter or other organs, through a mechanism of reflex spasm of intrarenal arterioles or ureters, leading to acute renal failure. It is a functional rather than parenchymal disease.
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PMID:Reflex anuria: an old concept with new evidence. 2397 16


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