Acute tubular necrosis

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Summary of Acute tubular necrosis

Acute tubular necrosis, one of the most common causes of acute kidney injury, is a medical condition involving the death of tubular epithelial cells which form the renal tubules of the kidneys. Common causes include ischemia and nephrotoxic drugs. The presence of granular, "muddy brown casts" of epithelial cells found in the urine during urinalysis is pathognomonic.. Management relies on aggressive treatment of the precipitating factors (e.g. hydration and cessation of the offending drug). Because tubular cells continually replace themselves, prognosis is good if the cause is corrected, and recovery is likely within 7 to 21 days.

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Acute tubular necrosis

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Acute tubular necrosis

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A 14-year-old girl comes to the emergency department because of worsening fatigue, nausea and vomiting for the past day. For the past week she has been receiving outpatient treatment of intravenous gentamicin for an infectious exacerbation of her longstanding bronchiectasis. She has type 1 diabetes and self-manages her insulin administration. She is afebrile, pulse is 92/min, respirations are 16/min, saturation is 96% on room air, and blood pressure is 142/86. An arterial blood gas shows pH 7.1, PaCO₂ 22 mmHg, PaO₂ 85 mmHg, and HCO₃ 14 mEq/L. Further blood results show an elevated serum blood urea nitrogen (BUN), creatinine and urea. Which of the following is the most likely diagnosis?