Differential Diagnosis for Acute Tubular Injury
- Single most likely diagnosis
- Acute Tubular Necrosis (ATN) due to ischemia or nephrotoxins: This is the most common cause of acute kidney injury in hospitalized patients, often resulting from decreased blood flow to the kidneys (ischemia) or exposure to nephrotoxic substances such as certain medications or toxins.
- Other Likely diagnoses
- Contrast-Induced Nephropathy (CIN): This condition occurs after the administration of contrast media used in imaging studies, particularly in patients with pre-existing kidney disease or other risk factors.
- Rhabdomyolysis: A condition where muscle tissue breaks down, releasing myoglobin into the blood, which can cause kidney damage and acute tubular necrosis.
- Sepsis: Severe infection can lead to acute kidney injury, including acute tubular necrosis, due to the inflammatory response and potential hypoperfusion of the kidneys.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Vasculitis: Inflammatory conditions affecting the blood vessels, such as ANCA-associated vasculitis, can cause kidney damage and must be promptly recognized and treated to prevent irreversible damage.
- Thrombotic Microangiopathy (TMA): Conditions like thrombotic thrombocytopenic purpura (TTP) or hemolytic-uremic syndrome (HUS) can cause acute kidney injury and have a high mortality rate if not promptly diagnosed and treated.
- Rare diagnoses
- Malaria: Certain types of malaria, particularly those caused by Plasmodium falciparum, can lead to acute kidney injury, including acute tubular necrosis, especially in severe cases.
- Leptospirosis: A bacterial infection that can cause kidney and liver failure, among other symptoms, and is more common in certain geographic areas or in individuals with specific occupational exposures.
- Hantavirus infection: Certain strains of hantavirus can cause hantavirus pulmonary syndrome (HPS) or hemorrhagic fever with renal syndrome (HFRS), both of which can involve acute kidney injury.