Acute Tubular Necrosis and Renal Failure in Patients with Glomerular Disease

Abstract

Renal failure is common in patients with glomerular disease. Although renal failure may result from the glomerular lesion itself, it is also observed in patients with minimal glomerular alterations. Degenerative changes and necrosis of the tubular epithelium are common findings in kidney biopsies from these patients. The aim of this work is to examine the association between acute tubular necrosis (ATN) and renal failure in patients with glomerulopathy and to estimate the relationship between the degree of ATN and renal failure in these patients. Data on age, sex, presence of nephrotic syndrome, and renal failure were recorded for 149 patients, who underwent a renal biopsy for the diagnosis of glomerulopathy. The biopsies were reviewed, and ATN, when present, was classified as one of four grades depending on its intensity. The mean age of the patients was 21 ± 16 years. Eighty patients (54%) were male, 43 (42%) had renal failure, 104 (72%) had nephrotic syndrome, and 66 (45%) had minimal change disease or focal segmental glomerulosclerosis. ATN was present in 115 (77%) patients. The frequency of renal failure was directly correlated with the intensity of ATN [odds ratio (OR) of 26.0 for patients with grade 2 lesions and OR of 45.5 for patients with grade 3 lesions]. ATN is a common finding in the biopsies of patients with glomerulopathy. The severity of ATN is directly associated with the frequency of renal failure in these patients.

Overexpression of Intrarenal Renin-Angiotensin System in Human Acute Tubular Necrosis

“…To further confirm the accuracy of the semi-quantitative grading of acute tubular injury, morphometry analysis was performed to quantitate the acute tubular injury in each slide [20]. Digital images of all microscopic fields in each slide were captured at 200 × magnification as described above.…”

“…Acute tubular injury was semi-quantitatively assessed by determining the degree of renal tubular necrosis (tubular dilatation, thinning of the tubular epithelium, or cellular casts) using a grading scale of 0 to 4, as described previously with minor modification [20]. Briefly, digital images (at 1360×1024 pixel resolution) of all microscopic fields in each slide were captured at 200 × magnification by the DP 71 CCD camera (Olympus) coupled to a microscope (Olympus, AX-70).…”

Mixed cryoglobulinemia and secondary membranoproliferative glomerulonephritis associated with ehrlichiosis

“…Kidney biopsy demonstrated two distinct types of renal injury, MPGN, and ATI, with the latter primarily contributing to acute kidney injury. At the time of biopsy, the patient had several risk factors for ATI including underlying nephrotic syndrome, hypotension, and sepsis [8,9]. The biopsy finding of MPGN explained the patient's nephrotic syndrome which preceded his episode of AKI.…”

Acute Oxalate Nephropathy Associated With Orlistat

“…ATN is a common finding on renal biopsies when an acute rise of creatinine is documented in sick inpatients (17,18).…”