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Long-Term Follow-up of Renal Function and Histology After Acute Tubular Necrosis

DONALD T. LEWERS, M.D.; TIMOTHY H. MATHEW, M.B.B.S., M.R.C.P.; JOHN F. MAHER, M.D., F.A.C.P.; and GEORGE E. SCHREINER, M.D., F.A.C.P.
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Supported in part by a grant from the John A. Hartford Foundation, Inc., New York, N.Y.; NIH Clinical Study grant RR-60-08, National Institutes of Health, Bethesda, Md.; training grant 2 T1 HE 5256, U.S. Public Health Service, Washington, D.C.; and the Georgetown University Kidney Fund, Washington, D.C. Dr. Lewers was supported by U.S.P.H.S Special Fellowship 5 FO3 AM 37, 975-02, National Institute of Arthritis and Metabolic Diseases, National Institutes of Health. Dr. Matthew was supported by a Pharmaceutical Manufacturers' Association Pharmacology-Morphology Fellowship, Washington, D.C.; and a Royal Australasian College of Physicians Overseas Scholarship, Melbourne, Australia.

▸Requests for reprints should be addressed to Donald T. Lewers, M.D., Maryland General Hospital, 827 Linden Ave., Baltimore, Md. 21201


Washington, D.C.


Ann Intern Med. 1970;73(4):523-529. doi:10.7326/0003-4819-73-4-523
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Renal function and histology were evaluated in 30 patients surviving acute tubular necrosis who were followed from 2 to 15 years. Clinical recovery was complete in all patients. Endogenous creatinine clearance was abnormal in 37%, whereas 47% failed to concentrate their urine to an osmotic urine to plasma ratio of 3.0. Two patients have an unexplained progressive deterioration in glomerular filtration rate. Ischemic acute tubular necrosis was followed by an abnormal creatinine clearance in 44% compared with 25% of those with a toxic cause. Toxic acute tubular necrosis was followed by a concentrating defect in 58% compared with 39% of the ischemic group. Phenolsulfonphthalein, intravenous pyelogram, maximal acid excretion, urinalysis, and urine cultures were abnormal in fewer patients. Renal histological changes were minimal and nonspecific. Patients recovering from acute tubular necrosis are clinically normal, and most have normal renal histology. Renal function will approach but not always achieve normal levels in the majority. Progressive deterioration of renal function may occasionally occur.

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