Acute Tubular Necrosis

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  1. Pathologic defect involves the renal tubules and adjacent parenchyma (i.e. tubulointerstitial injury)
    1. thought to be due to ischemia
  2. Proximal tubules fill with tubular epithelial cells that are sloughed into the lumen of the tubule; that mass of cells creates an obstruction that produces back pressure that reduces the net filtration pressure across the glomerular capillaries and decreases GFR
  3. Most often caused by sepsis, circulatory shock, and nephrotoxins such as aminoglycosides, amphotericin, contrast dye and myoglobin
  4. Diagnosis in setting of acute renal failure:
    1. UNa > 40 mEq
    2. FENa > 2%
    3. Remember: ATN spills a lot of salt appr
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