Renal transplants: can acute rejection and acute tubular necrosis
be differentiated with MR imaging?
STA: stable group of patients; ATN: group of patients with acute tubular necrosis
; AR: group of patients with acute rejection.
Table 1: Etiologies of Acute Kidney Injury in Lymphoma Pre-renal Intravascular volume depletion Nausea, emesis, diarrhea Hemorrhage Reduced kidney perfusion Vasoconstriction Sepsis Liver disease Medications (diuretics, nonsteroidal anti-inflammatory drugs) Renal Acute tubular necrosis
Kidney ischemia Tumour lysis syndrome Medications (acetaminophen, nonsteroidal anti-inflammatory drugs, aminoglycosides) Tubulointerstitial disorders Secondary kidney infiltration Primary kidney lymphoma Glomerular disorders Amyloidosis IgA nephropathy Renovascular disorders Renal vein thrombosis Thrombotic microangiopathy Post-Renal Obstruction Exterior compression (lymphadenopathy, obstructing tumour) Internal obstruction (nephrolithiasis, crystalluria) (*)Adapted from Luciano & Brewster (2014).
The patient also recovered from his acute tubular necrosis
. He was discharged to a rehabilitation facility off oxygen without any respiratory complaints, primarily for his critical illness polyneuromyopathy.
AKI is frequently observed after heart transplantation and is mainly related to acute tubular necrosis
. This was the case in our heart-transplant patient, who had suffered from several hemodynamic insults.
Wang, "Possible mechanisms explaining the tendency towards interstitial fibrosis in aristolochic acid-induced acute tubular necrosis
," Nephrology Dialysis Transplantation, vol.
Tubulointerstitial lesions were classified as tubulointerstitial nephritis, granulomatous nephritis, acute tubular necrosis
(nephrosis), tubular dilation and presence of bile pigment in the tubular epithelium.
In South Africa (SA) the three most common causes of AKI in older children are haemolytic uraemic syndrome (35%), acute tubular necrosis
(31%) and acute glomerulonephritis (GN) (16%), whereas 39% of AKI is caused by acute gastroenteritis and nephrotic syndrome in Nigeria,  and 26% was reported to be due to sepsis and malaria.
Nephrology literature suggests that a urine sediment "score" (Figure 1) consisting of the number of renal tubular epithelial cells per high power field and granular casts per low power field can be used to differentiate hospital-acquired AKI from acute tubular necrosis
(ATN) and acute renal failure caused by a sudden reduction in blood flow to the kidney (pre-renal AKI).
The two major causes of AKI developing in the hospital are prerenal disease and acute tubular necrosis
These findings are not specific, however, as they can also be seen with acute tubular necrosis
, acute rejection, and urinary obstruction [2, 4].
Acute tubular necrosis
due to ischemia or nephrotoxins leads to a marked increase in NGAL excretion .
Paraphenylene diamine induced acute tubular necrosis
following hair dye ingestion.
Acute renal graft dysfunction can be caused by acute rejection (AR), nephrotoxicity of calcineurin inhibitors (CNIs), acute tubular necrosis
(ATN) or ischemia/reperfusion lesions.