Albuminuria in acute tubular necrosis.

Acute renal failure (ARF) is defined as an abrupt decline in the glomerular filtration rate (GFR), as evidenced by rising serum levels of urea nitrogen and creatinine. Acute tubular necrosis (ATN) is the most common cause of ARF. ATN is an acute decline in glomerular filtration as a result of damage to the tubules in the kidney. Sepsis is the most common aetiology of ATN, causing ARF in 20–25% of normotensive patients and 50% of hypotensive patients [1]. The clinical diagnosis of ATN can be difficult as there are no uniform diagnostic criteria. Typical findings suggesting ATN are muddy brown granular or tubular epithelial cell casts, fractional excretion of sodium (FeNa) greater than 1%, and isosthenuria. ATN is not expected to affect the glomerulus, and thus should not cause glomerular proteinuria [2,3]. In this report, we describe a young woman with ARF and albuminuria who had biopsy-proven ATN but no glomerular pathology. The possible reasons for her albuminuria are discussed.