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Clinical Scenarios in Acute Kidney Injury: Parenchymal Acute Kidney Injury-Tubulo-Interstitial Diseases
Clinical Scenarios in Acute Kidney Injury: Parenchymal Acute Kidney Injury-Tubulo-Interstitial Diseases
- Publication Year :
- 2016
- Publisher :
- S. Karger AG, 2016.
-
Abstract
- Acute tubular necrosis (ATN) is the most common type of acute kidney injury (AKI) related to parenchymal damage (90% of cases). It may be due to a direct kidney injury, such as sepsis, drugs, toxins, contrast media, hemoglobinuria and myoglobinuria, or it may be the consequence of a prolonged systemic ischemic injury. Conventional ultrasound (US) shows enlarged kidneys with hypoechoic pyramids. Increased volume is largely sustained by the increase of anteroposterior diameter, while longitudinal axis usually maintains its normal length. Despite the role of color Doppler in AKI still being debated, many studies demonstrate that renal resistive indexes (RIs) vary on the basis of primary disease. Moreover, several studies assessed that higher RI values are predictive of persistent AKI. Nevertheless, due to the marked heterogeneity among the studies, further investigations focused on timing of RI measurement and test performances are needed. Acute interstitial nephritis is also a frequent cause of AKI, mainly due to non-steroidal anti-inflammatory drugs and antibiotics administration. The development of acute interstitial nephritis is due to an immunological reaction against nephritogenic exogenous antigens, processed by tubular cells. In acute interstitial nephritis, as well as in ATN, conventional US does not allow a definitive diagnosis. Kidneys appear enlarged and widely hyperechoic due to interstitial edema and inflammatory infiltration. Also, in this condition, hemodynamic changes are closely correlated to the severity and the progression of the anatomical damage.
- Subjects :
- Nephrology
medicine.medical_specialty
Pathology
business.industry
Myoglobinuria
Acute kidney injury
Hemodynamics
030208 emergency & critical care medicine
030204 cardiovascular system & hematology
medicine.disease
Sepsis
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Hemoglobinuria
business
Enlarged kidney
Acute tubular necrosis
Subjects
Details
- Database :
- OpenAIRE
- Accession number :
- edsair.doi...........9925431ddeb0689ff92a79ac111274c7
- Full Text :
- https://doi.org/10.1159/000445466