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Острый тубулярный некроз

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Última revisão: 16 Jan 2026
Última atualização: 29 Sep 2020

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • наличие факторов риска
  • олигурия или анурия
  • гипотензия
  • тахикардия
Detalhes completos

Outros fatores diagnósticos

  • плохое пероральное возмещение и анорексия
  • недомогание
  • жажда
  • головокружение
  • ортопноэ/диспноэ
  • отек
Detalhes completos

Fatores de risco

  • хроническая болезнь почек (ХБП)
  • хроническая гипертония
  • сахарный диабет
  • пожилой возраст
  • состояния с низкой перфузией
  • сепсис
  • обширное оперативное вмешательство
  • воздействие нефротоксических веществ
  • воздействие рентгенконтрастных препаратов
  • воздействие эндогенных токсинов
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • основной метаболический профиль (включая мочевину и креатинин)
  • отношение мочевина/креатинин
  • концентрация натрия в моче
  • осмоляльность мочи
  • фракционная экскреция натрия
  • фракционная экскреция мочевины
  • анализ осадка мочи
  • развернутый анализ крови
  • коагулограмма
  • миоглобин в моче
Detalhes completos

Investigações a serem consideradas

  • газы артериальной крови (ГАК)
  • исследования агрегации тромбоцитов
  • УЗИ
  • ЭКГ
  • диаметр нижней полой вены (НПВ), измеренный с помощью УЗИ
  • биопсия почки
  • биомаркеры сыворотки крови и мочи
Detalhes completos

Algoritmo de tratamento

AGUDA

острый тубулярний некроз (ОТН)

Colaboradores

Autores

Maria Jesus Lloret Cora, MD, MSc

Consulting Staff

Nephrology Department

Fundació Puigvert

Barcelona

Spain

Declarações

MJLC declares that she has no competing interests.

Leonor Fayos de Arizon, MD

Resident

Nephrology Department

Fundació Puigvert

Barcelona

Spain

Declarações

LFA declares that she has no competing interests.

Agradecimentos

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

Declarações

RT declares that she has no competing interests.

Revisores

Ajay Kumar, MD, FACP

Medical Director

Blood Management

Cleveland Clinic

Cleveland

OH

Declarações

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

Disclosures

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

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