ATN


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  • Names

    • ATN
    • acute tubular necrosis
    • acute tubular injury

  • Clinical

    • ischemic causes: shock
    • toxic causes: drugs, contrasts, heavy metals, rhabdomyolysis, hemolysis, toxins

  • Gross

    • edema
    • pale cortex
    • hyperemia at corticomedullary junction

  • Histology

    • tubular necrosis
      • coagulative necrosis
      • proximal > distal
    • tubular attenuation
      • flattenning of tubular epithelium
      • cells spread out, widely spaced nuclei, may have portions of denuded basement membrane
      • brush border loss
    • intrabubular casts, debris
    • interstitial edema
    • fibrosis if chronic
    • etiology specific patterns
      • isometric tubular vacuolization: IgG, vancomycin, calcineurin inhibitors
      • pigmented casts: rhabdomyolysis
      • birefringent oxalate crystals: ethylene glycol
      • tubular intranuclear inclusions: heavy metal exposures
      • nuclear atypia: chemotherapy, antivirals

  • Ddx

    • autolysis
      • has intact epithelial cells detached from tubular basement membrane
      • no edema, weight is not increased
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