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

Multiple factors still influence the high rate of mortality in acute tubular necrosis. Trying to analyze the influence of each risk factor present in an individual patient and the possible interdependence between these factors, as well as to obtain an early prognosis, we have applied a forward analysis to demographic data, acute renal failure origin, need of dialysis, diuresis and clinical conditions in 228 patients, using a multiple linear regression model contained in a computer package. Based on this approach we have found that three variables: deep neurological coma, persistent blood hypotension and assisted respiration have significant influence on mortality. Also, a regression equation was obtained which could be applied as a discriminant score to patient prognosis. This score, calculated with the three aforementioned variables and oliguria when the nephrologist sees the patient for the first time, allows an easy and early prognosis in each patient with acute tubular necrosis.
Nephron 1989
PMID:Easy and early prognosis in acute tubular necrosis: a forward analysis of 228 cases. 291 41

A review of 85 patients aged 60 years or more, treated in a southern Indian hospital for conditions requiring renal biopsy, showed that diffuse poliferative glomerulonephritis was the most frequent diagnosis, being present in 24 cases of whom 11 had elevated serum streptococcal antibody titres. Infections were also important in 2 patients with amyloidosis secondary to tuberculosis, in 3 patients with acute tubular necrosis following infectious gastroenteritis and in a patient with acute pyaemic interstitial nephritis with septicaemia. Drugs including indigenous medicines were the other important cause of renal disease, being implicated in 11 cases.
Nephron 1988
PMID:Medical renal disease in the elderly in a southern Indian hospital. 338 Feb 27

Five patients who developed acute renal failure due to acute tubular necrosis following multiple hornet (Vespa orientalis) stings are described. All of them had intravascular hemolysis. Evidence for rhabdomyolysis was present in 2 patients. Two patients had elevated transaminase and alkaline phosphatase levels and in 1 of these, liver biopsy showed centrilobular necrosis. Two patients had thrombocytopenia in the absence of disseminated intravascular coagulation. Two patients died of infections while the remaining 3 recovered completely. Acute renal failure following multiple hornet stings appears to result mainly from intravascular hemolysis or rhabdomyolysis although a direct nephrotoxic effect of venom cannot be excluded.
Nephron 1988
PMID:Acute renal failure following multiple hornet stings. 341 46

Elevated plasma renin activity (PRA) has been documented in patients with established acute renal failure. To study the association of PRA and renal dysfunction, 53 patients who were at risk of developing acute renal failure had serial measurements of PRA, renal function, and urinary beta 2-microglobulin. Those entered for study had pneumonia, septicaemia, volume loss with hypotension, or major surgical procedures with complications. Patients were divided into groups of abnormal or normal renal function. Abnormal renal function was defined by an elevated plasma urea and/or creatinine level with a submaximal urine urea to plasma urea ratio. The mean values of PRA for the abnormal and normal renal function groups, respectively, were 29 and 5.2 ng/ml/h (p less than 0.0001) and for beta 2-microglobulin 16.2 and 6.4 micrograms/l X 10(3) (p less than 0.0005). A linear regression of the logs of PRA to beta 2-microglobulin for the total group of patients gave an r value of 0.526 (p less than 0.001). These data show an association of PRA to renal dysfunction and tubular injury/dysfunction in the prerenal phase of renal failure, suggesting an effect of the renin-angiotensin system at this phase. It is not possible, however, to conclude from our study that the renin-angiotensin system has a direct role in the development of established acute tubular necrosis, since only 3 patients fell within this category.
Nephron 1986
PMID:Elevated plasma renin activity associated with renal dysfunction. 352 81

The incidence of acute tubular necrosis (need for hemodialysis immediately after transplantation) and its severity (the number of days dialysis was needed) were studied in 299 patients who were randomized prior to transplantation into undergoing splenectomy or not having splenectomy. There was no difference in the incidence of acute tubular necrosis between splenectomized and nonsplenectomized patients who received cadaveric grafts or kidneys from living related donors. In those patients in the cadaveric group who had acute tubular necrosis, the duration of need for dialysis was significantly less (p less than 0.05) in the splenectomized group (means = 8.9 days) when compared to the non-splenectomized group (means = 13.2 days). Animal experiments indicate that sustained prostaglandin release may be responsible for the decreased incidence and amelioration of acute tubular necrosis in splenectomized animals. Our study suggests that conclusions made in dogs about the influence of splenectomy on acute tubular necrosis may be applied to humans. Prostaglandin infusion may be a worthwhile method to abolish or ameliorate human acute tubular necrosis.
Nephron 1984
PMID:Influence of splenectomy on human acute tubular necrosis. 636

The capacity of exogenous amino acids to alter renal protein metabolism was studied during renal regeneration after mercuric chloride-induced acute tubular necrosis in the rat. In regenerating cortical tissue, the free leucine concentration was 17% lower than normal, and was decreased further after glucose infusion. The concentration was raised above normal by amino acid infusion thereby ameliorating the deficit of this amino acid. Synthesis and degradation of rapidly-turning over proteins in renal cortical cells was examined in vitro. Renal protein synthesis in cortical slices was assessed by measurements of tissue leucine specific radioactivity and cycloheximide-inhibitable [14C]leucine incorporation into protein. Protein synthesis in regenerating tissue was 52% higher than normal and was not increased further by glucose infusion. In contrast, amino acid infusion increased the rate 47% above that observed after an isocaloric glucose infusion, thereby demonstrating that amino acid enhancement of protein synthesis is superimposed upon the increased synthetic rate observed during renal regeneration. Renal protein degradation remained at the normal rate after amino acid infusion, but was increased in regenerating tissue and after glucose infusion. These results indicate that infused amino acids act on the kidney to enhance protein synthesis and reduce protein degradation in regenerating renal cells after acute tubular necrosis.
Nephron 1983
PMID:Amino acid administration enhances renal protein metabolism after acute tubular necrosis. 684 54

Sprague-Dawley rats given gentamicin from 10 to 70 mg/kg/day for 9 days showed a linear decrease in glomerular filtration rate with increasing dose, paralleled by histologic changes of acute tubular necrosis and cast formation only at the higher doses. Nephrotoxicity was correlated with the peak, rather than trough, serum gentamicin levels in this study, suggesting that it is the mean level of gentamicin over time that determines renal injury. The polyuria caused by gentamicin resulted mainly from a tubular concentrating defect rather than enhanced sodium or osmolal excretion and may be explained by the finding of a predominance of casts in the medullary thin limbs of the loops of Henle. No effect of gentamicin on the activity of cortical or medullary sodium-potassium adenosine triphosphatase was found to account for the modest sodium wasting. Concurrent administration of sodium cephalothin decreased the renal toxicity of gentamicin at high doses, an effect not explained by the added sodium or nonreabsorbable anion.
Nephron 1983
PMID:Features of gentamicin nephrotoxicity and effect of concurrent cephalothin in the rat. 687 60

5 patients with acute renal failure (3 with thrombopenia and hemolysis) induced by the reintroduction of rifampicin are described. No correlation was found between the severity of clinical manifestations and the total dose taken by the patients. In all but 1 patient, antirifampicin antibodies were detected. Antibodies suggested to be of the IgM class were detected in all 3 patients with hematological disorders. The pattern of non-specific acute tubular necrosis found in the 2 biopsied patients, indistinguishable from that of ischemic origin, raised the possibility of a vascular-mediated damage. In 3 patients, the possibility of a triggering immunoallergic mechanism is discussed.
Nephron 1982
PMID:Antirifampicin antibodies in acute rifampicin-associated renal failure. 712 59

A retrospective review of 27 patients with nonvisualization on 131I-orthoiodohippurate (Hippuran) renal scan during 1972--1977 was carried out. 5 patients had renal failure caused by urinary tract obstruction and of these, 4 were submitted to surgical relief. Varying levels of life-sustaining renal function were recovered in all 4 patients. 16 had chronic intrinsic renal disease, of whom 7 were admitted for reasons not directly related to renal failure. All of these required chronic dialysis within 3--6 months. The remaining 7 patients had acute renal failure (clinically, acute tubular necrosis) and none of them survived. It had been well established that the prognosis for recoverability of renal function is extremely poor in patients with nonvisualization on hippuran scan. It is important, therefore, to emphasize that nonvisualization on 131I-orthoiodohippurate renal scan in patients with urinary tract obstruction does not exclude the potential for recoverable renal function. Therefore, even in the absence of renal visualization, the need to definitively rule out urinary tract obstruction remains.
Nephron 1980
PMID:Obstructive uropathy in patients with nonvisualization on renal scan. 735 84

A previously described method for recovering a proximal renal tubular epitheal antigen (HRTE-1) from normal human kidney was modified by using ion-exchange and immunoaffinity chromatography in order to create easily reproducible conditions for antigen isolation. Radioiodinated HRTE-1 was then used to establish a 3-hour, double-antibody radioimmunoassay (RIA) for the purpose of testing whether the urinary excretion of this antigen might seve as a useful marker of acute tubular necrosis (ATN). Urines from 51 patients (ATN, 22: chronic nephropathies, 24; prerenal azotemia, 5) and from 36 normal subjects were assayed for HRTE-1. 79% of ATN patients had abnormal antigen concentrations while 100% of all other urines had urine antigen concentrations within a previously established range for random normal urine samples. When used as a differential diagnostic test of either ATN versus chronic nephropathies, or of ATN versus prerenal azotemia, 90 and 81% discrimination was achieved, respectively. The majority of ATN and prerenal azotemia patients presenting with atypical conventional diagnostic parameters (urine Na, urine osmolality, urine sediment, fractional Na excretion) were correctly diagnosed by RIA. Further study of HRTE-1 excretion in acute and chronic renal diseases seems indicated, both to elucidate pathophysiologic mechanisms and to determine whether HRTE-1 is a clinically useful marker of ATN.
Nephron 1980
PMID:Rapid radioimmunoassay for diagnosing acute tubular necrosis. 739 80


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