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]]