Figure 1221

Diagnosis of possible pigment-associated forms of acute renal failure (ARF). Once prerenal and postrenal forms of ARF have been ruled out and renal vascular, glomerular, and interstitial processes seem unlikely, a diagnosis of acute tubular necrosis (ATN) is probable. A diagnosis of ATN is thus one of exclusion (of other causes of ARF). In the majority of cases when ATN is present, one or more of the three predisposing conditions have been identified to be operational. These conditions include renal ischemia due to a prolonged prerenal state, nephrotoxin exposure, and sometimes pigmenturia. A diagnosis of ATN is supported by the absence of other causes of ARF, the presence of one or more predisposing factors, and the presence of urinary diagnostic indices and urinalysis suggested of ATN (see Figs. 12-15 and 12-16). A pigmenturic disorder (myloglobinuria or hemoglobin-uria) can predispose to ARF. This figure depicts the historical, physical examination, and supporting diagnostic tests that often lead to a diagnosis of pigment-associated ARF [19]. BUN—blood urea nitrogen; CK—creatinine kinase; SGOT—serum glutamic-oxaloacetic transaminase; LDH—lactic dehydrogenase.

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