Acute Tubular Necrosis

Acute Kidney Injury Masked by Malnutrition: A Case Report and the Problem of Protein

“…Acute tubular necrosis (ATN) is the most common cause of intrinsic AKI, resulting from prerenal AKI . ATN generally occurs in 3 phases: the initiation phase, the maintenance phase, and the recovery phase .…”

“…Acute tubular necrosis (ATN) is the most common cause of intrinsic AKI, resulting from prerenal AKI . ATN generally occurs in 3 phases: the initiation phase, the maintenance phase, and the recovery phase . The initiation phase occurs during the ischemic insult in which renal blood flow is significantly reduced, tubular cells are damaged, and the cascade of adverse events described above is triggered .…”

“…AKI etiology is also important to evaluate to help guide medical intervention . The cause(s) of AKI is (are) typically determined using a combination of blood tests, urinalysis, and renal ultrasound . The fractional excretion of sodium and urea in urine can be useful in identifying prerenal AKI .…”

“…8 The initiation phase occurs during the ischemic insult in which renal blood flow is significantly reduced, tubular cells are damaged, and the cascade of adverse events described above is triggered. 7,8 Ischemia also reduces the production of vasodilating chemicals by tubular epithelial cells, thereby worsening vasoconstriction and hypoperfusion. 8 During the maintenance phase (typically lasting 1-2 weeks), GFR stabilizes at a reduced level, and various complications may occur.…”

“…8 During the maintenance phase (typically lasting 1-2 weeks), GFR stabilizes at a reduced level, and various complications may occur. 8 These complications may include acid-base and electrolyte abnormalities, uremia, volume overload, and, less commonly, anemia, in-fections, respiratory dysfunction, cardiac dysfunction, and chronic kidney disease (CKD). During the recovery phase, tubular epithelial cells regenerate, sometimes resulting in a large urine volume and significant diuresis.…”