Acute Tubular Necrosis


Allergic Toxin Pigment Crystals Papillary Necrosis
Clinical Findings:
-RASH, FEVER with first dose
-IgE
-Eosinophils

MCC: Allopurinol
-Hx of Drugs
-Takes FEW DAYS
 - Amphotericin B
 - Aminoglycosides
 - Out-dated Tetracyclines
 
- K
- Myoglobin
-
Hx of terrible CRUSH injury = EKG Δ
 
- Oxylate
- Suicidal
- Anti-freeze: Ethyline Glycol Oxalic Acid   Binds Ca Ca Oxalate Crystals     
- Sudden Flank Pain
- NSAID
- Sickle Cell
- Looks like pyelonephritis but
(-) WBC,
(-) Culture
Best Initial Test
- Urinalysis: Eosinophilc uria
- WBC Cast
- Wright or Gemsa stain
  - Urinalysis: (+) blood but (-) RBC
NOTE:
K = Rhabdomyolysis = K
   
Most Accurate Test
- Biposy     - CT - Spiral CT
Management:
- STOP the drug
if BUN:Cr still elevated = Steroids.
- NO Tx
- Prevent with: Hydration
- Aggressive Hydrate
- Mannitol/Lasix
(put water in, mix, & take it out)
- Ca Gluconate to protect the heart
- IV Ethanol
- IV Fomepizol
= ? Dialysis
- None