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  1. #1
    galkim is offline Newbie 510 points
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    renal pathology question!

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    im going crazy over this:

    what is the difference between:

    1- papillary necrosis
    2- acute tubular necrosis
    3- renal tubular acidosis

    ???????????????????????????????????????

  2. #2
    USMLEs.99er is offline Newbie 510 points
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    Quote Originally Posted by galkim View Post
    im going crazy over this:

    what is the difference between:

    1- papillary necrosis
    2- acute tubular necrosis
    3- renal tubular acidosis

    ???????????????????????????????????????
    1. Necrosis of Papillary
    2. Acute Necrosis of Tubular
    3. Acidosis of Renal Tubular

    Get it?

  3. #3
    eldano is offline Newbie 510 points
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    Hey man be calm,

    So papillary necrosis is necrosis in one or all pyramids of the affected kidney.So you will notice the tips or distal areas of the pyramids with gray-white to yellow necrosis on macroscopic examination. But most importantly on microscopic examination you see areas of coagulative necrosis with renal tubules preservation. It's commonly a complication of acute pyelonephritis in pt with diabetes or urinary tract obstruction. So systemic symptoms may be present before the onset or determination of papillary necrosis.

    Acute Tubular Necrosis- is clinicopathologic entity characterized clinically by ACUTE diminution of renal function and often but no invariably, morphologic evidence of tubular injury. However, the Robbins tells you that oliguria is absent in 50 % of the pt with ATN. It's the most common cause of acute renal failure. And most of the time associated with:
    1- ischemia, due to decreased or interrupted blood flow
    2-direct toxic injury to the tubules (i.e. Acetaminophen being a very common)
    3-acute TUBULOINTERSITIAL nephritis (inflammation of the intersitium),
    4- Urinary obstruction
    5- Shock (septic, cardiac,neurogenic,volume) or hemorrhage
    Important to remember that this is REVERSIBLE diferent from papillary necrosis. ALSO microscopically is characterize by focal tubular epithelial necrosis at multiple points along the nephron, with large skip areas in between, often accompanied by rupture of the basement membrane(tubulorrhexis) and occlusion of tubular lumens by cast. The straight portion of the proximal tubule (needs lots of ATP to maintain the gradients) and the thick ascending in the renal medulla are specially vulnerable because this is a very low oxygen enviornment.
    IN TERMS OF THE PRESENTATION: pt with increasing oliguria, increase BUN, also a decresease urine osmolality (bc poor concentration ability of the kidney) and renal tubular cells presents on the urianalysis (which you should not expect to see)

    RENAL TUBULAR ACIDOSIS- is a inability of the kidney to maintain the acid-base balance leading to METABOLIC ACIDOSIS. The are differents causes of RTA like defectS in the H/K ATPase of collecting tubules (TYPE 1), defect in the HCO3 reabsortion (tipe 2) both leading to hypokalemia (so maybe your EkG will show and Flattened T waves and prominent U waves apparent QT interval prolongation looks like a " camel hump" or simply arrytmeas. But important in your differential diagnostic is that in order for this to occur the pt has to present with something that triggers this metabolic acidosis . Looks if they give you anormarlities in the urine ph cause that also can help you.

    So, in conclusion
    1-papillary necrosis- ischemic necrosis of the tip of renal papillae
    2-acute tubular necrosis acute diminution of renal function with evidence of tubular necrosis
    3-renal tubular acidosis- a group of renal defects leading to metabolic acidosis

    Well hope this longggggg message help you send me a message if you have more questions of and email
    Last edited by eldano; 10-24-2009 at 06:37 PM.

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