Acute tubular necrosis other diagnostic studies: Difference between revisions
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==Overview== | ==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== | ==Other Diagnostic Studies== | ||
* Renal biopsy: Finding of acute tubular necrosis on renal biopsy may include:<ref name="pmid23002699">{{cite journal |vauthors=Tavares MB, Chagas de Almeida Mda C, Martins RT, de Sousa AC, Martinelli R, dos-Santos WL |title=Acute tubular necrosis and renal failure in patients with glomerular disease |journal=Ren Fail |volume=34 |issue=10 |pages=1252–7 |date=2012 |pmid=23002699 |pmc=3496189 |doi=10.3109/0886022X.2012.723582 |url=}}</ref> | * Renal biopsy: Finding of acute tubular necrosis on renal biopsy may include:<ref name="pmid23002699">{{cite journal |vauthors=Tavares MB, Chagas de Almeida Mda C, Martins RT, de Sousa AC, Martinelli R, dos-Santos WL |title=Acute tubular necrosis and renal failure in patients with glomerular disease |journal=Ren Fail |volume=34 |issue=10 |pages=1252–7 |date=2012 |pmid=23002699 |pmc=3496189 |doi=10.3109/0886022X.2012.723582 |url=}}</ref> | ||
** Tubular dilatation and swollen tubular cells | ** Tubular dilatation and swollen tubular cells | ||
** Loss of tubular cells or the denuded tubules | ** Loss of tubular cells or the denuded tubules | ||
** Thinning of the tubular epithelium | ** Thinning of the tubular [[epithelium]] | ||
** Loss of the cell brush border | ** Loss of the cell brush border | ||
** Edema of the interstitium | ** [[Edema]] of the [[Interstitial|interstitium]] | ||
** Presence of cellular casts | ** 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 very early stage. | * 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.<ref name="pmid27670788">{{cite journal |vauthors=Ostermann M, Joannidis M |title=Acute kidney injury 2016: diagnosis and diagnostic workup |journal=Crit Care |volume=20 |issue=1 |pages=299 |date=September 2016 |pmid=27670788 |pmc=5037640 |doi=10.1186/s13054-016-1478-z |url=}}</ref><ref name="pmid15811437">{{cite journal |vauthors=Herget-Rosenthal S |title=One step forward in the early detection of acute renal failure |journal=Lancet |volume=365 |issue=9466 |pages=1205–6 |date=2005 |pmid=15811437 |doi=10.1016/S0140-6736(05)74787-5 |url=}}</ref><ref name="pmid19096722">{{cite journal |vauthors=Zhou H, Hewitt SM, Yuen PS, Star RA |title=Acute Kidney Injury Biomarkers - Needs, Present Status, and Future Promise |journal=Nephrol Self Assess Program |volume=5 |issue=2 |pages=63–71 |date=March 2006 |pmid=19096722 |pmc=2603572 |doi= |url=}}</ref><ref name="pmid16148039">{{cite journal |vauthors=Parikh CR, Abraham E, Ancukiewicz M, Edelstein CL |title=Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit |journal=J. Am. Soc. Nephrol. |volume=16 |issue=10 |pages=3046–52 |date=October 2005 |pmid=16148039 |doi=10.1681/ASN.2005030236 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
!BIomarker | !BIomarker | ||
| Line 37: | Line 28: | ||
|Produced by proximal tubular cells after ischaemic or nephrotoxic injury. Elevated levels are found in urine following tubular injury | |Produced by proximal tubular cells after ischaemic or nephrotoxic injury. Elevated levels are found in urine following tubular injury | ||
|- | |- | ||
|Cystatin C | |[[Cystatin C]] | ||
|Cysteine protease inhibitor filtered at the glomerulus | |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) | |Liver-type fatty acid binding protein (L-FABP) | ||
| Line 46: | Line 37: | ||
|Tubular enzymes are elevated in urine following renal tubular injury | |Tubular enzymes are elevated in urine following renal tubular injury | ||
|- | |- | ||
|Retinol binding protein (RBP) | |[[Retinol binding protein]] (RBP) | ||
|Produced by the liver and completely filtered by | |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 | |Alpha 1 microglobulin, Beta 2 microglobulin | ||
|Both are released in urine after renal tubular injury | |Both are released in urine after renal tubular injury | ||
|- | |- | ||
|Netrin-1 | |[[Netrin 1|Netrin-1]] | ||
|Increased expression can be found in damaged tubular cells and elevated levels are found in urine. | |Increased expression can be found in damaged tubular cells and elevated levels are found in urine. | ||
|} | |} | ||
Latest revision as of 19:36, 15 June 2018
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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.