Primary Acute Renal Failure (“Acute Tubular Necrosis”) in the Transplanted Kidney

Acute tubular necrosis (ATN) is the most common cause of acute renal failure. Early recognition of patients who are at risk for ATN can prevent or improve the course of ATN. Acute renal failure is classified as prerenal, intrinsic, or postrenal disease. ATN is classified as a type of intrinsic renal disease. The clinical course of ATN is divided into the renal failure phase, diuretic phase, and recovery phase, with each phase having distinct symptoms and laboratory findings. Diagnosis of ATN often is complicated and confusing; understanding of laboratory findings can facilitate the critical care nurse’s ability to assess those at risk for ATN. The care and treatment of the patient with ATN is complicated, and specific treatments are discussed in detail. The critical care nurse can play a vital role in identifying the patient at risk, preventing the development of ATN in those at risk, and providing appropriate care for those who develop ATN

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Management of Acute Renal Failure

Anaesthesia and Intensive Care ◽

10.1177/0310057x7200100109 ◽

1972 ◽

Vol 1 (1) ◽

pp. 65-69 ◽

Cited By ~ 2

Author(s):

J. M. Hayes

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Acute Tubular Necrosis ◽

Urinary Tract Obstruction ◽

Renin Angiotensin System ◽

Sodium Concentration ◽

Therapeutic Trial ◽

Angiotensin System ◽

Tubular Necrosis ◽

Occlusive Vascular Disease

Acute renal failure has oliguria and uraemia as its cardinal manifestations. The syndrome may be due to acute tubular necrosis, glomerulonephritis, urinary tract obstruction and occlusive vascular disease. The renal damage due to acute tubular necrosis is of uncertain aetiology. Renal cortical ischaemia and depression of glomerular filtration rate are important in the pathogenesis. Activation of the renin-angiotensin system and glomerular coagulation may prove to be important in these changes. The differentiation between reversible oliguria and established renal failure is generally accomplished on clinical grounds and the response to a therapeutic trial of mannitol. Measurement of urinary sodium concentration and osmolality are valuable adjuncts. The keystone of management is the prevention of symptomatic uraemia. Infection and haemorrhage have now replaced pulmonary oedema and hyperkalaemia as the major causes of death. The mortality rate remains high in acute tubular necrosis and a significant mortality occurs in the diuretic phase.

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IgA Nephropathy: Acute Renal Failure, Acute Tubular Necrosis, and Features of Postinfectious Acute Glomerulonephritis

Renal Failure ◽

10.3109/08860229209047662 ◽

1992 ◽

Vol 14 (4) ◽

pp. 533-539 ◽

Cited By ~ 3

Author(s):

Helga Maria Mazzarolo-Cruz ◽

Décio de Oliveira Penna ◽

Luis Balthazar Saldanha ◽

Elza Hissako Kanashiro ◽

Jenner Cruz ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Iga Nephropathy ◽

Acute Tubular Necrosis ◽

Acute Glomerulonephritis ◽

Tubular Necrosis

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Renal and Electrolyte Abnormalities in Heat Stroke during Hajj

Saudi Journal of Internal Medicine ◽

10.32790/sjim.1.2.5 ◽

2011 ◽

Vol 1 (2) ◽

pp. 33-35

Author(s):

Rana A. Nabalawi

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Acute Tubular Necrosis ◽

Heat Stroke ◽

Respiratory Alkalosis ◽

Summer Period ◽

Dry Skin ◽

Systemic Complications ◽

Tubular Necrosis ◽

Electrolyte Abnormalities

Background: Heat induced illnesses are variable from a mild heat exhaustion to a severe heat stroke and its systemic complications. Millions of pilgrims annually perform the Islamic obligatory mission of Hajj, are vulnerable to heat induced illnesses, especially when Hajj falls in the summer period. This is a retrospective study of the renal and electrolyte abnormalities in heat stroke patients during Hajj. Method: We selected randomly 472 patients out of 2044 patients diagnosed as heat stroke over 5 years from 1986-1991 for this study. The diagnosis of heat stroke was based on: 1) Rectal temperature > 40°C, 2) Hot dry skin and 3) Neurological deficit presenting as delirium, coma with or without convulsions. The renal function and electrolytes of all these patients were obtained. Results: All the 472 patients revealed significant electrolyte abnormalities: hypophasphatemia 98% (P + 0.55 ± 0.05 mmol/L), hyponatremia Na+ 70% (128 + 1 mmol/L), hypocalcemia 70% (Ca + 2.01 ± 0.02 mmol/L), hypokalemia 32% (K+3.3 ± 01 mmol/L), and hypomagnesaemia (Mg 0.06 ± 0.01 mmol/L) in 30%. Metabolic acidosis and compensatory respiratory alkalosis was seen in most patients. Acute renal failure that required dialysis developed in 180 (8.8%) patients. In 100 patients, the most common cause was Rhabdomyolysis (68%). The rest had ischemic acute tubular necrosis (32%) with a mortality of 15% compared to 20% in all the 472 patients. The risk mortality was higher in patients with a temperature of 42°C, comatose at presentation and older than 50 years. Conclusion: During Hajj, electrolyte abnormalities in heat stroke were found to be fairly common. Acute renal failure was mainly due to Rhabdomyolysis, which carry better prognosis compared to other causes of acute tubular necrosis.

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Syndrome of flank pain and acute renal failure after binge drinking and nonsteroidal anti-inflammatory drug ingestion.

Journal of the American Society of Nephrology ◽

10.1681/asn.v591647 ◽

1995 ◽

Vol 5 (9) ◽

pp. 1647-1652

Author(s):

G R Johnson ◽

S F Wen

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Binge Drinking ◽

Acute Tubular Necrosis ◽

Extracellular Volume ◽

Renal Perfusion ◽

Flank Pain ◽

Inflammatory Drug ◽

Tubular Necrosis ◽

Anti Inflammatory

The binge drinking of alcohol combined with the ingestion of a nonsteroidal anti-inflammatory drug (NSAID) is a recently described cause of reversible acute renal failure. The pathogenetic mechanisms leading to acute tubular necrosis in this setting include the initial compromise in renal perfusion due to alcohol-induced extracellular volume contraction and the superimposed renal hemodynamic alterations induced by the NSAID that interfere with the renal autoregulation. Although alcohol may also cause rhabdomyolysis leading to acute tubular necrosis, this is usually not apparent in these cases. Previously, only three such cases have been reported but the incidence is likely to be higher in view of the prevalence of alcohol and NSAID use. Herein is presented another patient in whom the features of flank pain and acute renal failure in association with binge drinking and NSAID ingestion constitute a characteristic syndrome.

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P. falciparum Malaria induced Renal impairment

The Journal of Medical Research ◽

10.31254/jmr.2019.5605 ◽

2019 ◽

Vol 5 (6) ◽

pp. 220-223

Author(s):

Tarkeswar Aich ◽

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Serum Creatinine ◽

Renal Dysfunction ◽

Falciparum Malaria ◽

Acute Tubular Necrosis ◽

Mean Value ◽

Intravascular Haemolysis ◽

Tubular Necrosis ◽

Oliguric Renal Failure

Introduction: The involvement of the kidney in falciparum malaria has been known for decades. In 1944, Spitz observed acute renal failure due to falciparum infection in soldiers during World War II. This observation was later supported by other workers who detected oliguria developing in patients with black water fever. The initial clinical pattern is that of reversible renal dysfunction or pre-renal azotemia, which rapidly progresses to acute tubular necrosis if treatment is not started early. Patients with malaria induced renal failure are hypercatabolic with blood urea and serum creatinine levels rising rapidly.Oliguric as well non-oliguric renal failure are observed and duration of oliguric renal failure ranges from a few days to several weeks depending on the severity of renal dysfunction. Acute renal failure in falciparum malaria is usually associated either with acute intravascular haemolysis or heavy parasitemia. Acute renal failure in falciparum malaria is also observed in patients with severe intravascular haemolysis resulting in haemoglobinuria. It may be induced by malarial fever or by anti-malarial drugs in a patient with or without G6-PD deficiency. Materials and Methods: This is a hospital based cross sectional study carried out in a total of 50 cases of acute renal failure who were selected from diagnosed patients of P. falciparum malaria. Cases were confirmed either by P. falciparum antigen test and/or peripheral blood smear test(both thick and thin smear).Malarial ARF (MARF) is diagnosed when serum creatinine level > 3 mg/dl, and/or urine output < 400 ml/24hrs despite adequate rehydration. Result: Out of 174 cases of falciparum malaria 50 patients (28.7%) had acute renal failure in falciparum malaria. 36 (72%) cases were males and 14 (28%) were females, indicating a much higher incidence in males. Approximately 78% of the cases in the present study were below the age of 40 years. The youngest was 15 years old and the oldest was 61 years old (Mean age – 32 ± 11.6 years). All were febrile (100%) and a majority had oliguria or anuria (72%); jaundice was detected in 30 (60%) patients on presentation. Hepatomegaly & Splenomegaly were found in 76% & 66% of the cases respectively. Out of the total 50 cases of malaria induced ARF, 14 cases (28%) had pre-renal ARF while in the majority, 72% the clinical course was that of ATN. The pathogenesis of ATN in the 36 cases was found to be heavy parasitaemia in 40% of the cases, IV hemolysis with haemoglobinuria in 3 (6%) of cases; and cholestatic jaundice in 26% of falciparum patients. Examination of the urinary sediments revealed that albumin was present in urine in 40 cases (80%). Majority of the patients had significant rise in blood urea level with a mean value of 177 mg. S. creatinine levels ranged between 3.2 - 13.6 mg with a mean value of 7.83 mg. The mean creatinine clearance rate was 11.71 ml/min. The overall mortality rate was 26%. Conclusion: AKI is common in Falciparum malaria. The pathogenesis of AKI is largely unknown but may be related to the erythrocyte sequestration and agglutination within the renal microcirculation interfering with flow and metabolism. Clinically and pathologically, this syndrome manifests as Pre-renal azotemia and acute tubular necrosis. Acute renal failure may occur simultaneously with other vital-organ dysfunction (in which case the mortality risk is high) or may progress as other disease manifestations resolve. Early dialysis or hemofiltration considerably enhances the likelihood of a patient’s survival, particularly in acute hypercatabolic renal failure. Severity of oliguria and presence of one or more associated complications like pulmonary oedema, acidosis, and altered sensorium have considerable influence on the outcome of the patients.

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Renal and Electrolyte Abnormalities in Heat Stroke during Hajj

Saudi Journal of Internal Medicine ◽

10.32790/sjim.2011.1.2.5 ◽

2011 ◽

Vol 1 (2) ◽

pp. 33-35

Author(s):

Rana A. Nabalawi

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Acute Tubular Necrosis ◽

Heat Stroke ◽

Respiratory Alkalosis ◽

Summer Period ◽

Dry Skin ◽

Systemic Complications ◽

Tubular Necrosis ◽

Electrolyte Abnormalities

Background: Heat induced illnesses are variable from a mild heat exhaustion to a severe heat stroke and its systemic complications. Millions of pilgrims annually perform the Islamic obligatory mission of Hajj, are vulnerable to heat induced illnesses, especially when Hajj falls in the summer period. This is a retrospective study of the renal and electrolyte abnormalities in heat stroke patients during Hajj. Method: We selected randomly 472 patients out of 2044 patients diagnosed as heat stroke over 5 years from 1986-1991 for this study. The diagnosis of heat stroke was based on: 1) Rectal temperature > 40°C, 2) Hot dry skin and 3) Neurological deficit presenting as delirium, coma with or without convulsions. The renal function and electrolytes of all these patients were obtained. Results: All the 472 patients revealed significant electrolyte abnormalities: hypophasphatemia 98% (P + 0.55 ± 0.05 mmol/L), hyponatremia Na+ 70% (128 + 1 mmol/L), hypocalcemia 70% (Ca + 2.01 ± 0.02 mmol/L), hypokalemia 32% (K+3.3 ± 01 mmol/L), and hypomagnesaemia (Mg 0.06 ± 0.01 mmol/L) in 30%. Metabolic acidosis and compensatory respiratory alkalosis was seen in most patients. Acute renal failure that required dialysis developed in 180 (8.8%) patients. In 100 patients, the most common cause was Rhabdomyolysis (68%). The rest had ischemic acute tubular necrosis (32%) with a mortality of 15% compared to 20% in all the 472 patients. The risk mortality was higher in patients with a temperature of 42°C, comatose at presentation and older than 50 years. Conclusion: During Hajj, electrolyte abnormalities in heat stroke were found to be fairly common. Acute renal failure was mainly due to Rhabdomyolysis, which carry better prognosis compared to other causes of acute tubular necrosis.

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