Overview: Pre-renal Disease and Acute Tubular Necrosis

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Overview Pre-renal Disease and Acute Tubular
Necrosis
By David I. Driver, MS III
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Introduction

• The incidence of acute renal failure, independent
  of underlying cause, varies widely based upon the
  definition utilized and the patient population.
  Reported rates have varied from 100 to 600 per
  million per year
• The incidence of acute renal failure is very high
  in hospitalized patients. An incidence of six
  percent has been reported among patients admitted
  to intensive care units, whereas among all
  hospitalized patients, rates of two to five
  percent have been reported

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Etiology

• The two major causes of acute renal failure
  developing in the hospital are acute tubular
  necrosis and prerenal disease
• Other, less common causes of acute renal failure
  can be diagnosed from their characteristic
  features in the history, urinalysis, and, if
  indicated, ultrasonography. These include
• Urinary tract obstruction, usually evident as
  hydronephrosis on ultrasonography.
• Acute interstitial nephritis, typically with a
  history of an offending drug plus a urinalysis
  showing red and white cells and, in many cases,
  eosinophils and white cell casts.
• Acute glomerulonephritis, generally with
  urinalysis showing red cells, red cell casts, and
  proteinuria.

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Diagnosis

• Prerenal disease and postischemic or nephrotoxic
  ATN can usually be distinguished by complete
  examination of the urine and by serial
  measurements of the BUN and plasma creatinine
  concentration.
• The major distinguishing findings between
  prerenal disease and ATN include
• BUN/plasma creatinine ration
• Rate of rise of plasma creatinine concentration
• Urinalysis
• Urine sodium concentation
• Fractional excreation of sodium
• Urine osmolality
• Urine volume
• Urine to plasma creatinine concentration
• Novel markers
• Neutrophil gelatinase-associated lipocalin

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