Revision 3 for 'Acute tubular necrosis'

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Acute tubular necrosis

Acute tubular necrosis refers to intrinsic renal failure secondary to reduced tubular flow rate. It is the most common intrinsic cause of acute kidney injury and often reversible. 2,3,4

Pathology

Acute tubular necrosis is characterized by renal tubular cell damage and death and is usually caused by ischemic or nephrotoxic insults. Deposition of cellular debris within the tubules results in oliguria. 

Etiology

Hypovolemic event

  • dehydration
  • blood loss
  • septic shock
  • renal transplant

Drugs

  • amphotericin B
  • radiocontrast media
  • cisplatin
  • sulfa drugs
  • antiviral (acyclovir, cidofovir, foscarnet)
  • immunosuppressant (tacrolimus, cyclosporine, everolimus)
  • chemotherapy (cisplatin, ifosfamide, temsirolimus)

Radiographic features

In acute tubular necrosis, cellular debris deposits within and obstructs the tubules. Imaging demonstrates preserved renal parenchyma perfusions with minimal or absent excretion into the pelvicalyceal system.

Fluoroscopy / CT IVP

Contrast imaging typically demonstrates gradual or immediate dense nephrogram. Delayed 24 hours imaging would also demonstrate persistent nephrogram or striated nephrogram due to stasis of contrast within the renal tubules. 3,4

Ultrasound

Routine ultrasounds are usually performed to assess the renal parenchyma and exclude other causes of obstruction. In acute tubular necrosis, kidneys are enlarged and increased echogenicity. 5

Nuclear medicine

Renal scintigraphy assists to differentiate acute tubular necrosis from other conditions with other irreversible causes of renal failure such as renal cortical necrosis. It may also be performed for post renal transplant assessment.
Renal perfusion is preserved during angiographic phase with a gradual increase of radiotracer due to minimal or absent excretion. 1

See also

 

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