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

The clinical patterns of acute renal failure have changed in the past 10 to 15 years. Nonoliguric acute tubular necrosis has become more common, as has nephrotoxic acute tubular necrosis. Other syndromes that have increased in incidence are acute tubular necrosis secondary to rhabdomyolysis and acute renal failure secondary to nonsteroidal anti-inflammatory drugs. Calculation of the fractional sodium excretion or the renal failure index helps distinguish between prerenal azotemia and acute tubular necrosis. In a significant number of patients with acute renal failure, a kidney biopsy may be necessary to establish the correct diagnosis and initiate the appropriate therapy.
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PMID:New concepts in acute renal failure. 351 96

Renal involvement in legionnaires' disease is a well-known, yet incompletely understood, complication. Manifestations of renal involvement include proteinuria, hematuria, pyuria, cylindruria, and azotemia. Previous cases of legionnaires' disease with renal involvement have shown pathophysiologic changes consistent with acute tubulointerstitial nephritis or acute tubular necrosis. A toxic metabolite produced by Legionella pneumophila has been theorized to produce a vasoconstrictive effect on the renal microvasculature, leading to ischemia and renal dysfunction. The case reported here is unique in that the patient presented with interstitial nephritis in the absence of pulmonary signs or symptoms.
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PMID:Interstitial nephritis in a patient with Legionnaires' disease. 380 71

Renal involvement is a well described complication of Legionnaires' disease and is often manifested as mild, transient azotemia, hematuria, proteinuria, pyuria or cylinduria. Acute renal failure complicating Legionnaires' disease has also been described, and some patients have required hemodialysis. Renal morphology has only been described in a few cases. We report two cases of Legionnaires' disease who developed acute renal failure. The serotype of the Legionella pneumophilia isolated from one of the patients had never been isolated from humans before. This patient expired and at autopsy the kidney revealed acute tubular necrosis, but there was no evidence for interstitial or glomerular disease. Renal morphology in six previously reported cases revealed acute tubulointerstitial nephritis in three cases and acute tubular necrosis in the other three. We conclude that acute renal failure may accompany severe Legionnaires' disease, and the development of the renal failure is not related to hemodynamic factors, while nephrotoxic antibiotics may be a contributing factor.
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PMID:Legionnaires' disease associated with acute renal failure: a report of two cases and review of the literature. 388 29

Oliguria has been considered a cardinal feature of acute renal failure. However, many recent reports indicate that acute renal failure usually occurs in the setting of well-maintained urine output. Moreover, the nonoliguric state may accompany acute renal failure due to pre- and post-renal azotemia and a variety of renal parenchymal disorders, as well as acute tubular necrosis. Most studies indicate that nonoliguric forms of acute renal failure are associated with less morbidity and mortality than oliguric acute renal failure. Uncontrolled studies also suggest that volume expansion, potent diuretic agents, and renal vasodilators can convert oliguric to nonoliguric acute tubular necrosis if administered early in the course of acute renal failure. However, prospective studies of early intervention in oliguric patients are needed.
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PMID:Nonoliguric acute renal failure. 389 1

Determining the cause of acutely deteriorating renal function is a common problem in clinical nephrology. The fractional excretion of filtered sodium (FENa) has been demonstrated to be a reliably discriminating test between prerenal azotemia and acute tubular necrosis. However, with increasing clinical use of the FENa, numerous reports of low FENa (less than 1%) have appeared. The clinical settings of these reports include oliguric and nonoliguric acute tubular necrosis, urinary tract obstruction, acute glomerulonephritis, hepatorenal syndrome, renal allograft rejection, sepsis, and drug-related alterations in renal hemodynamics. One particular urinary index cannot be expected to reliably discriminate between prerenal azotemia and acute renal failure in all cases. The utility of the FENa test in the differential diagnosis of acute renal failure must be interpreted in conjunction with the patient's clinical course and the use of additional urinary and serum tests.
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PMID:Fractional excretion of sodium. Exceptions to its diagnostic value. 397 Jun 21

Nitrilotriacetate (NTA), an effective metal-chelating agent, has been used as a substitute for polyphosphates in household laundry detergents. Nephrotoxicity and renal tumorigenicity have been reported in experimental animals that received high doses of NTA po for 4 weeks to 2 years. Since NTA exists in water as a variety of NTA-metal complexes, it was important to investigate the biological effects of NTA in a complexed form. In this study, acute and subchronic toxicity of a ferric iron chelate of NTA (Fe-NTA) was investigated in rats. When Fe-NTA was given ip, acute tubular necrosis and renal failure occurred following a single injection of 15 mg iron/kg. Repeated injections of sublethal doses produced degeneration and necrosis of the proximal tubular epithelium and was associated with polyuria, glucosuria, aminoaciduria, and azotemia. After 9 days of treatment, regeneration of the tubular epithelium with atypical cells was observed. Except for a parenchymal iron deposit, no marked changes were observed in other organs. None of these effects were observed in animals given noncomplexed NTA. In conclusion, the toxicity observed following high doses of NTA given po may be the result of an absorbed metal-NTA chelate.
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PMID:Acute renal failure and glucosuria induced by ferric nitrilotriacetate in rats. 397 99

A dog with oliguric acute renal failure presumed to have been caused by ethylene glycol ingestion was treated by hemodialysis for 1 month. Hemodialysis was effective in controlling azotemia, hyperphosphatemia, and hyperkalemia when performed on a daily or alternate-day basis. The major complications during treatment were infection and severe weight loss. Serial renal biopsies disclosed a progression from initial acute tubular necrosis to severe diffuse interstitial fibrosis and mononuclear cell inflammation. Infection, cachexia, development of end-stage renal lesions, and terminal hyperkalemia contributed to the eventual death of the dog.
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PMID:Hemodialysis of a dog with acute renal failure. 401 97

A study was conducted in oliguric and acutely azotemic patients, measuring: (i) the fractional excretion of sodium (FENa) using creatinine clearance as a measure of glomerular filtration rate, and (ii) sodium clearance relative to urea clearance, designated as the sodium/urea clearance ratio (Na:urea CR). It was found that FENa discriminated between "tubular" and "non-tubular" disorders in 96% of patients. Further, Na:urea CR was as discriminating as FENa. Patients with Na:urea CR above 2.5% can be reliably diagnosed as having acute tubular necrosis or acute urinary tract obstruction; those with a value less than 2.5% will have acute glomerulonephritis or pre-renal azotemia. As urea and sodium measurements are so readily available, this test can now be applied in the assessment of the oliguric or acutely azotemic patient in any hospital practice.
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PMID:A simple aid to the differential diagnosis of oliguria. 658 51

The present prospective study was undertaken to evaluate the usefulness of urinary chloride concentration in determining the cause of an abrupt decline in renal function. 99 patients from diverse clinical settings with multiple causes of acute renal failure were evaluated. Urinary chloride concentrations of less than 20 mEq/l were observed in most cases of reversible prerenal azotemia (20 of 21 cases) and were observed in more frequently than urinary sodium concentration of less than 20 mEq/l (13 of 21 cases, p less than 0.01). Only prerenal azotemia accompanying diuretic use was associated with high urinary chloride concentrations (57 +/- 7 mEq/l). When prerenal azotemia occurred in the setting of metabolic alkalosis with bicarbonaturia, urinary chloride was low (4.0 +/- 1.0 mEq/l) while urinary sodium was high (65.0 +/- 19.0 mEq/l). In patients with oliguric and nonoliguric acute tubular necrosis, and in patients with acute exacerbations of chronic renal failure, mean urinary chloride concentration ranged from 40 to 67 mEq/l and mean fractional excretions of chloride ranged from 7.2 to 8.4%. Only 11% of patients with oliguric and nonoliguric acute tubular necrosis had urinary chloride concentrations of less than 20 mEq/l. Urinary chloride concentrations exhibited greater sensitivity and equivalent specificity as urinary sodium concentrations in differentiating patients with reversible prerenal azotemia from those with oliguric and nonoliguric acute tubular necrosis.
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PMID:Urinary chloride concentration in acute renal failure. 670 May 67

The computed radionuclide urogram is advocated as a noninvasive diagnostic method for differentiation of the most common prerenal, renal, and postrenal causes of acute renal failure. On the basis of characteristic changes in the effective renal plasma flow rate, the calculated filtration fraction, and the calculated glomerular filtration rate, prerenal conditions such as renal artery stenosis or thrombosis, renal conditions such as acute rejection or acute tubular necrosis, and postrenal conditions such as obstruction or leakage, which are the most common causes of acute renal failure, can be differentiated. In conjunction with morphologic criteria derived from sonograms, a diagnosis with acceptable confidence can be rendered in most instances. Both the computed radionuclide urogram and sonogram are noninvasive and can be used without adverse effects in the presence of azotemia and even anuria. This also makes feasible reexamination at intervals to assess effect of therapy and offer prognostic information.
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PMID:Computed radionuclide urogram for assessing acute renal failure. 676 41


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