Acute tubular necrosis (ATN) presenting with an unusually prolonged period of marked polyuria heralded by an abrupt oliguric phase

Virin Ramoutar

Cristian Landa

Leighton James

^{Department of Internal Medicine, University of Florida, Jacksonville, Florida, USA}

^{Division of Nephrology & Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, USA}

^{Dr Virin Rajiv Neil Ramoutar,}ude.lfu.xaj@ratuomar.niriv

Accepted 2014 Aug 7.

Abstract

A 50-year-old African-American man presented with acute tubular necrosis (ATN) secondary to hypotension from non-typhoid Salmonella gastroenteritis and bacteraemia. The oliguric phase lasted only 24 h followed by prolonged polyuria for 20 days, with urine output in excess of 16 L/day at maximum. As indexed in PubMed this is only the second published case of this nature since 1974, in which an abrupt oliguric phase of 24 h or less heralded prolonged polyuria in ATN. The diagnosis is challenging as fractional excretion of sodium early in the clinical course and rapid normalisation of serum creatinine with intravenous fluids (IVF) may point towards prerenal azotaemia resulting in a premature discharge from hospital. Patients with an abrupt oliguric phase may suffer a secondary renal insult from the profound fluid loss that is to follow and may need inpatient monitoring with supplemental IVF to prevent deleterious outcomes.

Abstract

Italicised data represents days when no intravenous fluid was given.

*This data represents documentation as noted in the nursing and electronic medical record. The patient was advised to consume fluids ad lib and this may result in an underestimation of total daily fluid intake.

Crea, creatinine; LOS, length of stay; Na, sodium; Osm Calc, calculated osmolality; UOP, urine output.

Learning points

Acknowledgments

The authors would like to thank Vishal Jaikaransingh, MD Fellow in Nephrology, PGY-4 UT Southwestern Medical Center Dallas, Texas; and Gretchen Kuntz, MSW MLIS Director, Borland Library, University of Florida-Jacksonville.

Acknowledgments

Footnotes

Competing interests: None.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

Footnotes

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