Long-Term Follow-Up of Renal Function after Recovery from Acute Tubular Necrosis

Abstract

The management of acute renal failure (ARF) was dramatically altered in 1945 by the successful use of hemodialysis by Kolff [1] in a patient with acute postoperative renal failure and by the improved understanding of the basic principles of fluid and electrolyte management [2, 3]. Attention at first naturally focused on the impact of these newer forms of management on the immediate prognosis, particularly since it appeared that if death during the acute phase could be prevented, complete clinical recovery was the rule. Study of the literature, however, shows that even from the late forties it was becoming apparent that recovery, although complete in the clinical sense, was not necessarily complete as regards renal function. Burwell et al. [4] reported a patient who developed ARF following abortion and died three months later after a good clinical recovery. Death was due to serum hepatitis, but at postmortem examination the kidneys showed minor but definite abnormalities, including subcapsular scarring, lymphocytic foci, and some dilated tubules with flattened epithelium. Marshall and Hoffman [5] reported delayed recovery of renal function in three out of four patients, and in four cases of acute tubular necrosis (ATN) due to carbon tetrachloride poisoning, Sirota [6] observed that although renal function usually returned to the lower limit of normal, there might be some residual vascular damage.