Louis, a 60-year-old male, has not been feeling himself lately. He has been drow

Question

Louis, a 60-year-old male, has not been feeling himself lately. He has been drowsy and fatigued. He becomes short of breath walking from one room to the next. On a recent visit, his daughter noticed that he seemed to be scratching a lot. His legs, ankles, and feet were extremely swollen and his shortness of breath was becoming worse. He began to complain of chest pain, and was immediately taken to emergency room. A review of Louis’ medical history revealed that he was currently being treated for a urinary tract infection. His infection was resistant to the antibiotics that he was initially treated with. He began treatment with gentamicin 5 days ago. Physical examination confirmed the observations of Louis’ daughter. A urinary catheter was placed in Louis’ bladder in order to determine urine output. A sample was sent to the laboratory for analysis. His urine analysis showed cloudy, dark urine. Casts were seen. A diagnosis of acute renal failure due to nephrotoxic acute tubular necrosis (ATN) was made

1. What is the pathophysiology associated with nephrotoxic acute tubular necrosis?

2. What is the most likely cause of Louis’ condition?

3. What are the clinical manifestations of pain that Louis demonstrates?

4. How can Louis be diagnosed?

5. What is the treatment for Louis?

Explanation / Answer

1). Acute tubular necrosis is the kidney disease which is caused due to decreased airflow and oxygen to the tissues of the kidney. The two types of ATN are,

Toxic ATN occurs due to certain medications such as aminoglycoside, statins and other cytotoxic drugs (e.g. cisplatin). It is characterized by necrosis of the proximal tubular epithelium, and the necrotized cells fall into the lumen of the tubule. However, the glomeruli are not affected in general. Regeneration of the tubular epithelium is possible as the basement membrane is intact.

Ischemic ATN occurs due to the inadequate kidney perfusion for prolonged periods of time, which may due to the shock, embolism of the renal arteries, or other kidney conditions. The proximal tubule and the thick ascending limb require significant levels of ATP and are most affected by the ischemic damage. Ischemic damage also raises the cytosolic calcium levels, free radical formation, and disruption of the membrane phospholipids.

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