{"id":9951,"date":"2022-01-07T21:06:36","date_gmt":"2022-01-07T19:06:36","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/acute-tubular-necrosis-rhabdomyolysis-contrast-material-nephropathy\/"},"modified":"2022-01-08T12:07:42","modified_gmt":"2022-01-08T10:07:42","slug":"acute-tubular-necrosis-rhabdomyolysis-contrast-material-nephropathy","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/acute-tubular-necrosis-rhabdomyolysis-contrast-material-nephropathy\/","title":{"rendered":"Acute tubular necrosis, rhabdomyolysis, contrast-material nephropathy"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Acute tubular necrosis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Acute tubular necrosis (ATN) describes an<strong> intrarenal form<\/strong> of acute kidney injury in which the tubules become damaged and dysfunctional, due to <strong>hypoperfusion<\/strong> and\/or <strong>nephrotoxins<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Accounts for the majority of intrinsic acute kidney injury cases.<\/li><li>Depending on the severity, may be asymptomatic, but in severe cases, presents with <strong>initial oliguria<\/strong> with azotemia and uremia (lasting 1-3 weeks), followed by <strong>diuretic phase<\/strong> (increased diuresis, due to fluid overload).<\/li><li>When comparing ATN to prerenal AKI:<ul><li>Prerenal AKI appears with a much higher BUN\/creatinine ratio (>20)<\/li><li>ATN appears with low osmolality (&lt;350) and high urine sodium (>40)<\/li><\/ul><ul><li>Oliguria in prerenal AKI can be corrected with fluid resuscitation, but in ATN it cannot be.<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology and pathophysiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\" id=\"block-9a50260b-15b9-4191-b78f-5284fbfbbf75\"><li>The tubular cells are highly sensitive to hypoperfusion and nephrotoxins.<ul><li><strong>Hypoperfusion <\/strong>leads to inadequate renal blood supply, typically in the cause of severe hypotension, shock, sepsis, DIC, and acute heart failure.<\/li><li><strong>Nephrotoxins <\/strong>include certain drugs (aminoglycosides, amphotericin B, NSAIDs), toxins (heavy metals, ethylene glycol), myoglobin, contrast agents.<\/li><\/ul><\/li><li>Characterized by the loss of cell polarity and redistribution of ion channels, sloughting off of cells and obstruction of the lumen, increased permeability, decreasing GFR and urine output.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Elevated serum creatinine (>0.3mg\/dL)<\/li><li>Urinalysis<ul><li>Low urine osmolality<\/li><li>Appearance of Tamm-Horesfall casts<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Remove the nephrotoxin and restore the perfusion.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Rhabdomyolysis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Rhabdomyolysis is massive muscle damage, leading to the release of large quantities of myocyte products including myoglobin, creatine kinase, and electrolytes.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Myalgia<\/li><li>Weakness<\/li><li>Dark urine<\/li><li>Acute kidney injury (in severe cases)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Elevated CK levels (can be over 5 times above normal)<\/li><li>Urinalysis demonstrating myoglobinuria; dipstick test can detect it<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Extreme exercise, especially in those who are untrained<\/li><li>Mechanical trauma (crush syndrome)<\/li><li>Extreme temperatures<\/li><li>Statins<\/li><li>Infections<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>IV fluids<\/li><li>Hemodyalysis<\/li><li>Alkalization of the urine is beneficial in some cases (potassium citrate)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Contrast-induced nephropathy<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<p class=\"wp-block-paragraph\">Contrast agents are nephrotoxic and they may induce acute kidney injury, usually 1-2 days after administration. <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The exact mechanism is unknown, but is associated with vasoconstriciton and cytotoxic activity.<\/li><li>Rare in normally-functioning kidneys, and is associated with underlying diseases such as diabetes, CVD, old age, and renal impairment, especially under dehydration and metformin usage.<\/li><li>Newer contrast agents have a much lower osmolality, reducing the risk for AKI.<\/li><li><strong>Presentation<\/strong>. In many cases, the AKI is mild and asymptomatic; however, severe cases may present with oliguria, azotemia, and uremia.<\/li><li><strong>Diagnosis<\/strong>. Elevated Scr.<\/li><li><strong>Treatment<\/strong>. IV fluids.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Prevention<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<p class=\"wp-block-paragraph\">Prior to a referral for contrast-imaging, kidney function should be evaluated (GFR, Scr), and the patient should discontinue metformin and NSAID usage.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Proper hydration before and after the procedure is important, and IV fluids to produce mild volume expansion (in patients without HF) is recommended in patients at high risk.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Acute tubular necrosis<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology and pathophysiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Rhabdomyolysis<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Presentation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Contrast-induced nephropathy<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Prevention<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Acute tubular necrosis Acute tubular necrosis (ATN) describes an intrarenal form of acute kidney injury in which the tubules become damaged and dysfunctional, due to hypoperfusion and\/or nephrotoxins. Accounts for the majority of intrinsic acute kidney injury cases. Depending on the severity, may be asymptomatic, but in severe cases, presents with initial oliguria with azotemia [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":19,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9951","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Acute tubular necrosis, rhabdomyolysis, contrast-material nephropathy &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/acute-tubular-necrosis-rhabdomyolysis-contrast-material-nephropathy\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/acute-tubular-necrosis-rhabdomyolysis-contrast-material-nephropathy\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/acute-tubular-necrosis-rhabdomyolysis-contrast-material-nephropathy\\\/\",\"name\":\"Acute tubular necrosis, rhabdomyolysis, contrast-material nephropathy &#8211; 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