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Differences between different causes of intrinsic Acute Kidney Injury
How can the different causes of intrinsic Acute Kidney Injury be differentiated?
Although there are no specific therapies for the treatment of Acute Tubular Necrosis, specific therapies are available for many of the other forms of intrinsic Acute Kidney Injury.
Diagnostic clues may be apparent from the history and physical examination, paying careful attention to
(1) the history of medication use;
(2) medical procedures; and
(3) careful examination of the skin for evidence of vasculitis, drug eruption, and atheroembolism.
Examination of the urine often provides key findings for differentiating between the etiologies of intrinsic Acute Kidney Injury.
A definitive diagnosis may result in the requirement of a kidney biopsy.
Urine Findings in Intrinsic Acute Kidney Injury
| AGN/RPGN | AIN | ATN | Crystal Nephropathies | Myeloma kidney |
|---|---|---|---|---|
| Dysmorphic RBCs RBC Casts | RBCs WBCs WBC casts eosinophiluria | Tubular epithelial cells Coarse granular casts (“muddy brown” casts) | Crystaluria Oxalate—ethylene glycol Urate—tumor lysis syndrome Drug—acyclovir, indinavir | Bence-Jones proteinuria Free urinary light chains |
AIN , Acute interstitial nephritis; AGN , acute glomerulonephritis; ATN , acute tubular necrosis; RBC , red blood cell; RPGN , rapidly progressive glomerulonephritis; WBC , white blood cell.
