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Pathology - Acute tubular injury
Definition: Acute renal impairment resulting from damage to renal tubules.
Epidemiology • A prevalent etiology of acute renal failure (ARF).
Aetiology • Ischemia resulting from extended hypoperfusion. • Nephrotoxins including pharmaceuticals, radiological contrast agents, uric acid, hemoglobin, myoglobin, and ethylene glycol.
Pathogenesis: Tubular epithelial cells have high metabolic activity and are highly susceptible to injury from ischemia or toxins.
Presentation: ARF. Macroscopy • The kidneys exhibit hypertrophy, with a mass exceeding 200 grams. The renal cortex exhibits a pale appearance on the sliced surface.
Histopathology:The affected tubules exhibit dilation, accompanied by the flattening of tubular epithelial cells and the disappearance of the brush boundary. Casts of desquamated necrotic epithelial cells may be observed in the lumen of distal tubules. • The interstitial compartment is enlarged due to edema, although there is no substantial infiltration of inflammatory cells. • Indicators of the underlying etiology may be evident, such as birefringent oxalate crystals in cases of ethylene glycol poisoning or pigmented casts in rhabdomyolysis.
Prognosis: Typically linked to a serious circulatory abnormality and a significant death rate.
Definition: Acute renal impairment resulting from damage to renal tubules.
Epidemiology • A prevalent etiology of acute renal failure (ARF).
Aetiology • Ischemia resulting from extended hypoperfusion. • Nephrotoxins including pharmaceuticals, radiological contrast agents, uric acid, hemoglobin, myoglobin, and ethylene glycol.
Pathogenesis: Tubular epithelial cells have high metabolic activity and are highly susceptible to injury from ischemia or toxins.
Presentation: ARF. Macroscopy • The kidneys exhibit hypertrophy, with a mass exceeding 200 grams. The renal cortex exhibits a pale appearance on the sliced surface.
Histopathology:The affected tubules exhibit dilation, accompanied by the flattening of tubular epithelial cells and the disappearance of the brush boundary. Casts of desquamated necrotic epithelial cells may be observed in the lumen of distal tubules. • The interstitial compartment is enlarged due to edema, although there is no substantial infiltration of inflammatory cells. • Indicators of the underlying etiology may be evident, such as birefringent oxalate crystals in cases of ethylene glycol poisoning or pigmented casts in rhabdomyolysis.
Prognosis: Typically linked to a serious circulatory abnormality and a significant death rate.
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