Ischemic ATN
Nephrotoxic ATN
Garbage Pile

A marker of acute kidney injury with acute tubular necrosis when present in the urine.

What are renal tubular epithelial cells?


Decreased blood flow results in release of this vasoconstrictor from endothelial cells in ischemic ATN.

What is endothelin?


Aminoglycoside intracellular accumulation trapping occurs in this area of the nephron.

What is proximal tubule? 

(Specifically, S1 and S2 segments; S3 also after kidney ischemia.)

Bonus 100 Points: What is the MOA of aminoglycosides?


The criteria for diagnosing acute kidney injury.

What is Kidney Disease: Improving Global Outcomes (KDIGO)?


Evaluates blood flow into and out of the kidneys, especially to determine if there is narrowing of the renal blood vessels.

What is renal artery doppler ultrasound?


Prognosis of ATN.

What is good? 

Bonus 200 Points: Under what circumstances is prognosis for ATN bad?


BAD LUCK! Your team loses 100 points for choosing this one.



GOOD LUCK! Your team gains 100 points for absolutely no reason.



The two types of postrenal AKI.

(Hint: categories, not specific disease processes)

What is extrarenal obstruction & intrarenal obstruction?

Bonus 300 Points: What are the most likely areas in the urinary tract where obstruction would occur?


Activates arteriolar constriction or dilation based on NaCl concentration of luminal fluid.

What is macula densa?


The clinical phases of ATN.

What is initiation, maintenance, and recovery phases? (Some sources include "extension phase")

Bonus 500 Points: What occurs in these phases?


Most common areas of nephron to get ischemic ATN.

What are proximal tubule & thick ascending limb of Henle?

Bonus 100 Points: Why?


Endogenous toxins that can cause nephrotoxic ATN.

(Name two.)

What are myoglobin, hemoglobinuria, uric acid, & monoclonal light chains?


Calculate Christine Baldwin's FENa percentage.

What is 2.10%?


Any 3 of the most common organisms that cause UTIs.

What are E. coli, Klebsiella, Proteus, Enterobacter, & Enterococcus?


What is expected FENa in intrarenal AKI?

What is > 2%? (increased)


Late histopathological findings of ischemic acute tubular necrosis.

What is regeneration of epithelia (dilated tubular lamina, flattened epithelium, and large nuclei with prominent nucleoli and mitotic activity)?


Exogenous toxins that cause nephrotoxic ATN.

(Name three, excluding aminoglycosides.)

What are cisplatin, amphotericin B, NSAIDs, heavy metals, ethylene glycol, radiocontrast agents, and organic solvents?


The FENa value of a patient with prerenal disease and is currently taking diuretics.

What is greater than 1%?

Bonus 200 Points: What FENa values help you differentiate between the different renal diseases?

Opposite Team Bonus 300 Points: What is the advantage of FEUrea over FENa?


Management of recurrent UTIs.

What is optimizing personal hygiene, using vitamin C as a urinary acidifier, taking precautions after sexual contact, and using prophylactic antibiotics or antiseptics such as nitrofurantoin and methenamine?

(Anything within this realm.)


Expected BUN:Creatinine ratio in intrarenal AKI.

What is < 15? (decreased)


Two early histopathological signs of ischemic ATN.

What are swelling of cell, focal tubular epithelial necrosis, apoptosis and desquamation of cells in tubular lumen, dilated proximal tubules with loss or thinning of brush border, granular casts, hyaline casts, pigmented casts - especially in distal and collecting ducts, WBC in dilated vasa recta, interstitial edema, & eosinophilic hyaline casts of Tamm-Horsfall protein?


Mismatched blood transfusions and other hemolytic crises causing hemoglobinuria & skeletal muscle injuries causing myoglobinuria can result in ischemic/nephrotoxic ATN.

What is combination of ischemic and nephrotoxic ATN?

Hemolytic crises: ischemia

Toxic iron content of globin molecules: nephrotoxic


The four structures involved in intrinsic AKI.

What are tubules, glomeruli, interstitium, & intra-renal blood vessels?


Quadratus lumborum counterstrain points.

What are 12th ribs, just lateral to lumbar transverse processes, and iliac crest?

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