Acute tubular necrosis

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Acute tubular necrosis

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Questions

USMLE® Step 1 style questions USMLE

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A 45-year-old man is brought to the emergency department for evaluation following a motor vehicle accident. Trauma chest/abdomen/pelvis CT-imaging demonstrates multiple bilateral fractures, a right humeral shaft fracture, as well as splenic and liver lacerations with ongoing internal hemorrhage. The patient is resuscitated with type O negative blood and is taken to the operating room for repair of the aforementioned injuries. His condition remains stable postoperatively. Following surgery, his temperature is 38.0°C (100.4°F), pulse is 95/min, respirations are 20/min, and blood pressure is 115/70 mmHg. On his second day of hospitalization, his urine output decreases. Urine microscopy demonstrates granular casts and a calculated fractional excretion of sodium (FENa) of 3%. On the patient’s eighth day of hospitalization, a significant increase in urine output is noted. Serum creatinine charting is shown:

 
 
 Laboratory value  Result 
 Urinalysis 
  On admission  Day 2  Day 8 
Creatinine  1.1 mg/dL  3.5 mg/dL  2.3 mg/dL 
   In the coming days, this patient is at highest risk of developing which of the following findings? 

External References

First Aid

2024

2023

2022

2021

Acute tubular necrosis p. 620

Aminoglycosides p. 188

acute tubular necrosis p. 621

Cisplatin p. 445

acute tubular necrosis p. 621

Granular casts p. 612

acute tubular necrosis p. 621

Heart failure p. 316

acute tubular necrosis with p. 620

Hemoglobinuria

acute tubular necrosis and p. 621

Hemorrhage

acute tubular necrosis p. 621

Hypotension

acute tubular necrosis with p. 621

Ischemia p. 206, 685

acute tubular necrosis from p. 620

Lead poisoning p. 425, 430

acute tubular necrosis p. 620

Myoglobinuria

acute tubular necrosis p. 621

Sepsis

acute tubular necrosis p. 621

Shock p. 317

acute tubular necrosis p. 621

Tubular necrosis p. 612, 620, 620

Summary

Acute tubular necrosis (ATN) is a type of acute kidney injury (AKI) that results in the sudden and rapid death of tubular cells in the kidneys. This can lead to a decrease in urine production and an increase in the levels of creatinine and urea in the blood.

ATN may be caused by sepsis leading to hypotension and renal hypoperfusion; ischemia due to renal hypoperfusion, like in hypovolemic shock; but it can also be due to exposure to toxins and nephrotoxic drugs which cause damage to the tubular cells. Such drugs include nephrotoxic antibiotics, contrast agents used during imaging studies, amphotericin B, and toxic heavy metals.

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