ACUTE TUBULAR NECROSIS

Question 1

What is acute tubular necrosis?

Answer 1

Death of tubular epithelial cells that form the renal tubules

Question 2

What are two types of acute tubular necrosis?

Answer 2

Toxic

Ischaemic

Question 3

What is the consequence of acute tubular necrosis?

Answer 3

Acute kidney injury

Question 4

What is the mortality rate of acute tubular necrosis?

Answer 4

50%

Question 5

What are the causes of ischaemic acute tubular necrosis?

Answer 5

Hypotension and hypovolaemic shock following:

Trauma
Infection
Burns
Haemorrhage

Question 6

What does histological examination of someone with ischaemic acute tubular necrosis reveal?

Answer 6

Infiltration of inflammatory cells
Flattened and vacuolated tubular cells
Interstitial oedema
Cellular debris and protein casts in the distal tubule and collecting ducts
Myoglobin in the casts in crush injuries

Question 7

What medications can increase the likelihood of developing ischaemic acute tubular necrosis?

Answer 7

NSAIDs - prevent synthesis of prostaglandins and hence protective vasodilation

Question 8

What are the toxins that can cause acute tubular necrosis?

Answer 8

Organic solvents - Carbon tetrachloride in dry cleaning fluid
Heavy metals - gold, mercury, lead and arsenic
Pesticides

Question 9

What are the medications that can cause toxic tubular necrosis?

Answer 9

Antibiotics - Gentamicin

Question 10

Which part of the nephron is damaged in toxic acute tubular necrosis?

Answer 10

The proximal tubule

Question 11

What is the prognosis of toxic acute tubular necrosis?

Answer 11

Usually good with spontaneous recovery occuring in most people due to regeneration of epithelial cells.