Acute tubular necrosis other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
Renal biopsy and detection of various novel biomarkers in the serum and urine can be helpful in diagnosing acute tubular necrosis.
Other Diagnostic Studies
- Renal biopsy: Finding of acute tubular necrosis on renal biopsy may include:[1]
- Tubular dilatation and swollen tubular cells
- Loss of tubular cells or the denuded tubules
- Thinning of the tubular epithelium
- Loss of the cell brush border
- Edema of the interstitium
- Presence of cellular casts
- Novel biomarkers: Evaluation of various urinary and serum biomarkers may be helpful in patients with acute tubular necrosis to identify renal tubular injury at the very early stage.[2][3][4][5]
| BIomarker | Finding |
|---|---|
| Neutrophil gelatinase-associated lipocalin (NGAL) | Elevated levels are found in urine following tubular injury |
| Interleukin-18 (IL-18) | Elevated levels of IL-18 are found in urine after renal tubular injury. |
| Kidney Injury Molecule-1 (KIM-1) | Produced by proximal tubular cells after ischaemic or nephrotoxic injury. Elevated levels are found in urine following tubular injury |
| Cystatin C | Cysteine protease inhibitor filtered at the glomerulus and reabsorbed at the proximal tubule without secretion. Elevated levels in urine may be found after tubular insult. |
| Liver-type fatty acid binding protein (L-FABP) | Produced in proximal tubular cells and in the liver. Elevated levels are found in urine following tubular injury. |
| Tubular enzymes: Alpha glutathione S-transferase, pi-glutathione S-transferase, N-acetyl-beta-glucosaminidase | Tubular enzymes are elevated in urine following renal tubular injury |
| Retinol binding protein (RBP) | Produced by the liver and completely filtered by glomeruli and reabsorbed, bot secreted by proximal tubular cells. It is released into urine following injury involving renal tubules. |
| Alpha 1 microglobulin, Beta 2 microglobulin | Both are released in urine after renal tubular injury |
| Netrin-1 | Increased expression can be found in damaged tubular cells and elevated levels are found in urine. |
References
- ↑ Tavares MB, Chagas de Almeida Mda C, Martins RT, de Sousa AC, Martinelli R, dos-Santos WL (2012). "Acute tubular necrosis and renal failure in patients with glomerular disease". Ren Fail. 34 (10): 1252–7. doi:10.3109/0886022X.2012.723582. PMC 3496189. PMID 23002699.
- ↑ Ostermann M, Joannidis M (September 2016). "Acute kidney injury 2016: diagnosis and diagnostic workup". Crit Care. 20 (1): 299. doi:10.1186/s13054-016-1478-z. PMC 5037640. PMID 27670788.
- ↑ Herget-Rosenthal S (2005). "One step forward in the early detection of acute renal failure". Lancet. 365 (9466): 1205–6. doi:10.1016/S0140-6736(05)74787-5. PMID 15811437.
- ↑ Zhou H, Hewitt SM, Yuen PS, Star RA (March 2006). "Acute Kidney Injury Biomarkers - Needs, Present Status, and Future Promise". Nephrol Self Assess Program. 5 (2): 63–71. PMC 2603572. PMID 19096722.
- ↑ Parikh CR, Abraham E, Ancukiewicz M, Edelstein CL (October 2005). "Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit". J. Am. Soc. Nephrol. 16 (10): 3046–52. doi:10.1681/ASN.2005030236. PMID 16148039.