Acute tubular necrosis
1626304
225751701
2008-07-15T06:22:26Z
Rcej
1612789
unreferenced
{{unreferenced|date=July 2008}}
{{Infobox_Disease |
Name = Acute tubular necrosis |
Image = |
Caption = |
DiseasesDB = 11263 |
ICD10 = {{ICD10|N|17|0|n|17}} |
ICD9 = {{ICD9|584.5}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = med |
eMedicineTopic = 39 |
eMedicine_mult = {{eMedicine2|ped|28}} |
MeshID = D007683 |
}}
'''Acute tubular necrosis''' or ('''ATN''') is a medical condition involving the death of tubular cells that form the [[tubule]] that transports [[urine]] to the [[ureter]]s while reabsorbing 99% of the water (and highly concentrating the salts and metabolic byproducts). Tubular cells continually replace themselves and if the cause of ATN is removed then recovery is likely. ATN presents with [[acute renal failure]] and is one of the most common causes of ARF. The presence of "muddy brown casts" of epithelial cells found in the urine during [[urinalysis]] is pathognomonic for ATN.
It may be classified as either ''toxic'' or ''[[Ischemia|ischemic]]''. Toxic ATN occurs when the tubular cells are exposed to a toxic substance ([[nephrotoxic]] ATN). Ischemic ATN occurs when the tubular cells do not get enough oxygen, a condition they are highly sensitive to due to their very high [[metabolism]].
==Toxic ATN==
Toxic ATN can be caused by free [[hemoglobin]] or [[myoglobin]], by medication such as [[antibiotic]]s and [[cytostatic]] drugs, or by intoxication ([[ethylene glycol]], "anti-freeze").
[[Histopathology]]: Toxic ATN is characterized by proximal tubular epithelium necrosis (no nuclei, intense eosinophilic homogeneous cytoplasm, but preserved shape) due to a toxic substance (poisons, organic solvents, drugs, [[heavy metals]]). Necrotic cells fall into the tubule [[lumen]], obliterating it, and determining acute renal failure. Basement membrane is intact, so the tubular epithelium regeneration is possible. [[Glomeruli]] are not affected.
==Ischemic ATN==
Ischemic ATN can be caused when the [[kidneys]] are not sufficiently perfused for a long period of time (i.e. [[renal artery stenosis]]) or during [[Shock (medical)|shock]]. [[Hypoperfusion]] can also be caused by [[embolism]] of the renal arteries.
Ischemic ATN specifically causes ''skip lesions'' through the tubules.
==External links==
*Photo at: [http://www.pathologyatlas.ro/Toxic%20tubular%20necrosis%202.html Atlas of Pathology]
*[http://www.nephrologychannel.com/atn/ Acute Tubular Necrosis]
{{Nephrology}}
[[Category:Nephrology]]
{{disease-stub}}
[[da:Akut tubolo-interstitiel nefropati]]