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Acute tubular necrosis

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Последний просмотренный: 24 Jan 2026
Last updated: 29 Sep 2020

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • oliguria or anuria
  • hypotension
  • tachycardia
Полная информация

Другие диагностические факторы

  • poor oral intake and anorexia
  • malaise
  • thirst
  • dizziness
  • orthopnea/dyspnea
  • edema
Полная информация

Факторы риска

  • chronic kidney disease (CKD)
  • chronic hypertension
  • diabetes mellitus
  • advanced age
  • low-perfusion states
  • sepsis
  • major surgery
  • exposure to nephrotoxic agents
  • exposure to radiocontrast media
  • exposure to endogenous toxins
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • basic metabolic profile (including BUN and creatinine)
  • BUN-to-creatinine ratio
  • urine sodium concentration
  • urine osmolality
  • fractional excretion of sodium
  • fractional excretion of BUN
  • urinalysis for sediment
  • CBC
  • coagulation studies
  • urinary myoglobin
Полная информация

Исследования, проведение которых нужно рассмотреть

  • arterial blood gases (ABG)
  • platelet aggregation studies
  • ultrasound
  • ECG
  • inferior vena cava (IVC) diameter measured by ultrasound
  • renal biopsy
  • serum and urinary biomarkers
Полная информация

Алгоритм лечения

Острый

acute tubular necrosis (ATN)

Составители

Авторы

Maria Jesus Lloret Cora, MD, MSc

Consulting Staff

Nephrology Department

Fundació Puigvert

Barcelona

Spain

Раскрытие информации

MJLC declares that she has no competing interests.

Leonor Fayos de Arizon, MD

Resident

Nephrology Department

Fundació Puigvert

Barcelona

Spain

Раскрытие информации

LFA declares that she has no competing interests.

Выражение благодарностей

Dr Maria Jesus Lloret Cora would like to gratefully acknowledge Dr Roser Torra, the previous contributor to this topic.

Раскрытие информации

RT declares that she has no competing interests.

Рецензенты

Ajay Kumar, MD, FACP

Medical Director

Blood Management

Cleveland Clinic

Cleveland

OH

Раскрытие информации

AK has received a fee for speaking about perioperative blood management from Ortho-Biotech and has also received reimbursement from medscape.com for the education webcast of the same presentation.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Раскрытие информации

IM declares that he has no competing interests.

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Disclosures

RT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: epidemiology, diagnosis, and management. Chest. 2005 Oct;128(4):2847-63. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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