Acute Tubular Necrosis

Question 1

ARF
Intrarenal azotemia

Answer 1

Injury and necrosis of tubular epithelial cells

Question 2

Urine in ACUTE tubular necrosis ?

Answer 2

1. Brown
2. Granular casts

Question 3

ATN what happening ?

Answer 3

Necrotic cell plug tubules and dec GFR

126

Question 4

Etiology of ATN ?

Answer 4

1. Ischemic
2. Nephrotoxic

Question 5

ATN manifestation ?

same as Long standing obstruction Postrenal azotemia ARF

Answer 5

5. Serum BUN:Cr < 15
6. Urine osmolarity < 500 mOsm/kg
7. Tubular function intact
8. FENa > 2%

Question 5

Ischemic ATN ?

Answer 5

1. dec blood supply
2. Necrosis of tubules
3. Preceded by prerenal azotemia

Question 6

Ischemic ATN damage site >?

Answer 6

1. Proximal tubule
2. Medullary segment of the thick Ascending limb

Question 7

Nephrotoxic ATN site >?

Answer 7

Proximal tubule

Question 8

Nephrotoxic ATN cause ?

Answer 8

Toxic agents - Necrosis of tubules

Question 9

Causes more —-

Answer 9

1. Aminoglycosides-Most common
2. Heavy metals - Lead
3. Myoglobinuria -crush injury to muscle
4. Ethylene glycol -Oxalate crystals in urine
5. Radiocontrast dye
6. Urate -Tumor Lysis Syndrome

Question 10

ATN progression ?

Answer 10

Reversible
Oliguria can persist for 2-3 weeks before recovery

pathoma 127

Question 11

Clinical features of ATN ?

Answer 11

1. Oliguria
2. Inc BUN
3. Inc Cr
4. Brown granular casts
5. Hyperkalemia
6. Dec renal excretion
7. Metabolic acidosis

Question 11

Tx of ATN ?

Answer 11

1. Hydration
2. Allopurinol

Question 12

How reenter cell cycle and regenerate ?

Answer 12

Tubular cells/Stable cells