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Renal Failure Secondary to Acute Tubular Necrosis*: Epidemiology, Diagnosis, and Management

Namita Gill, MD; Joseph V. Nally, Jr, MD; Richard A. Fatica, MD
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*From the Departments of General Internal Medicine (Dr. Gill) and Nephrology and Hypertension (Drs. Nally and Fatica), Cleveland Clinic Foundation, Cleveland, OH.

Correspondence to: Namita Gill, MD, Cleveland Clinic Foundation, General Internal Medicine, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: gilln1@ccf.org



Chest. 2005;128(4):2847-2863. doi:10.1378/chest.128.4.2847
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Acute tubular necrosis (ATN) is a form of acute renal failure (ARF) that is common in hospitalized patients. In critical care units, it accounts for about 76% of cases of ARF. Despite the introduction of hemodialysis > 30 years ago, the mortality rates from ATN in hospitalized and ICU patients are about 37.1% and 78.6%, respectively. The purpose of this review is to discuss briefly the cause, diagnosis, and epidemiology of ARF, and to review in depth the clinical trials performed to date that have examined the influence of growth factors, hormones, antioxidants, diuretics, and dialysis. In particular, the role of the dialysis modality, dialyzer characteristics, and dosing strategies are discussed.

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