Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

At present, ultrasonography (US) is not able to define the type of renal damage and therefore cannot replace percutaneous renal biopsy in the diagnosis of acute kidney disease. It is, however, the most immediate and safest imaging technique for the evaluation of patients with acute kidney injury (AKI) in order to exclude urinary tract obstruction or chronic kidney disease and guide clinical decision-making. In prerenal AKI caused by cardiorenal syndrome type 1, US does not show specific signs. However, in these patients, pleuropulmonary US is the first-choice imaging technique to evaluate the congestion of subpleural interlobular septa and to identify and count lung comet tails. In cardiorenal syndrome type 2, US visualizes signs of systemic overload (right pleural effusion, liver stasis, overdistention and rigidity of the inferior vena cava and suprahepatic veins). In acute tubular necrosis (ATN), the most common type of AKI, gray-scale US is nonspecific and shows enlarged kidneys with hypoechoic pyramids due to medullary edema. The resistance index (RI) is a very useful marker to establish the severity of ATN and the required follow-up, and to evaluate functional recovery, since its reduction precedes the normalization of serum creatinine. US is the technique of choice in the diagnosis of obstructive nephropathy, where it is highly sensitive (>95%) but less specific (<70%). The primary objective of this review is to analyze the applications of US in the diagnosis of prerenal, renal and postrenal AKI.
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PMID:[Ultrasound and color Doppler in nephrology. Acute kidney injury]. 2311 40

Renal transplantation is the treatment of choice for end-stage renal disease in children. As a technically demanding surgery with complex medical management, it is associated with a number of complications. Anatomic imaging including ultrasonography with color and spectral Doppler and functional assessment with renal perfusion scintigraphy are complementary for the detection and characterization of posttransplant complications. Complications can be characterized by the time of appearance after transplantation (immediate, early, or late) or the anatomic site of origin (perinephric, vascular, urologic, or renal parenchymal). Perinephric fluid collections include hematomas and seromas, abscesses, lymphoceles, and urinomas. Noninfected collections frequently resolve spontaneously but should be monitored to exclude progression. Vascular complications are more prevalent in pediatric patients because of the small vessel caliber and include vascular thrombosis and stenosis. Arteriovenous fistulas and pseudoaneurysms can complicate biopsy and are typically transient. Common urologic complications include urine leak and urinary tract obstruction. Renal perfusion scintigraphy can be invaluable in elucidating the nature of such complications. Renal parenchymal abnormalities include acute tubular necrosis, rejection, and toxic effects of medication. Imaging features of renal parenchymal abnormalities can overlap, and the primary role of imaging is to exclude alternative causes of renal dysfunction. Renal and nonrenal mass lesions are more common in immunosuppressed patients after transplantation. Familiarity with the normal imaging appearance of the renal allograft and the appearances of common complications facilitates accurate diagnosis and timely treatment, with the ultimate goal of increasing graft survival. This goal is particularly crucial in children, given their greater number of projected life years.
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PMID:Imaging of pediatric renal transplants and their complications: a pictorial review. 2402 22

The annual incidence is about 150 per million in the UK, but this figure is six times greater in the >80 years old group. Prerenal azotemia is considered as the most serious reason in community or hospital acquired acute renal failure (ARF). A 67-year-old middle age male was admitted to the hospital with a chief complaint of generalized weakness, volume depletion and dysuria. He has treated with metronidazole for diarrhoea caused by Clostridium difficile considered as the precipitating factor for the ARF. The patient has severe osteoarthritis and takes high dose non-steroidal anti-inflammatory drugs from the last two years. He also complains for obstructive sleep apnea (OSA) and obesity. He has controlled hypertension was on lisinopril to control blood pressure. ARF is quite common, occurring in 80 million populations. Urinary obstruction should be excluded (a cause in around 5-10 of cases) because this is readily reversible if it is diagnosed early. A renal US will be sufficient to identify obstruction in 95 of cases. Most cases of ARF are expected to pre renal failure/acute tubular necrosis (ATN) 70-80%. Risk factor for development for at ATN are old age, drugs (non-steroidal anti-inflammatory drugs, gentamicin), sepsis, and chronic kidney disease and must be considered.
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PMID:Overview of management of acute renal failure and its evaluation; a case analysis. 2819 69


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