Acute Tubular Necrosis

Ischemic injury to the donor organ during harvesting and subsequent transplantation into the patient, is a common cause of oliguria/anuria in the immediate post-transplant period. The clinical course is usually self-limited, and recovery ensues within a few weeks. Biopsies of the allograft during the ischemic phase show coarse irregular cytoplasmic vacuoles in the renal tubular epithelium and focal coagulative necrosis. During the resolution phase of the injury, the tubules may only show non-specific dilatation, cast formation, and regeneration. The peri-tubular capillaries sometimes show extra-medullary hematopoiesis. In the glomeruli, severe ischemic injury may result in capillary thrombi and neutrophilic infiltration.


  1. Olsen S, Burdick JF, Keown PA, et al. Primary acute renal failure ("acute tubular necrosis") in the transplanted kidney: morphology and pathogenesis. Medicine (Baltimore) 1989;68(3):173-187.
  2. Solez K, Kramer EC, Fox JA, et al. Medullary plasma flow and intravascular leukocyte accumulation in acute renal failure. Kidney Int 1974;6(1):24-37.

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Last Modified: Thu Jun 18 10:14:08 EDT 2009


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