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Acute tubular necrosis (ATN) presenting with an unusually prolonged period of marked polyuria heralded by an abrupt oliguric phase.
[typhoid]
A
50
-
year
-old
African-
American
man
presented
with
acute
tubular
necrosis
(
ATN
)
secondary
to
hypotension
from
non-
typhoid
Salmonella
gastroenteritis
and
bacteraemia
.
The
oliguric
phase
lasted
only
24
 
h
followed
by
prolonged
polyuria
for
20
 
days
,
with
urine
output
in
excess
of
16
 
L
/
day
at
maximum
.
As
indexed
in
PubMed
this
is
only
the
second
published
case
of
this
nature
since
1974
,
in
which
an
abrupt
oliguric
phase
of
24
 
h
or
less
heralded
prolonged
polyuria
in
ATN
.
The
diagnosis
is
challenging
as
fractional
excretion
of
sodium
early
in
the
clinical
course
and
rapid
normalisation
of
serum
creatinine
with
intravenous
fluids
(
IVF
)
may
point
towards
prerenal
azotaemia
resulting
in
a
premature
discharge
from
hospital
.
Patients
with
an
abrupt
oliguric
phase
may
suffer
a
secondary
renal
insult
from
the
profound
fluid
loss
that
is
to
follow
and
may
need
inpatient
monitoring
with
supplemental
IVF
to
prevent
deleterious
outcomes
.
Diseases
Validation
Diseases presenting
"hypotension"
symptom
achondroplasia
adrenal incidentaloma
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cutaneous mastocytosis
fabry disease
familial mediterranean fever
primary effusion lymphoma
scrub typhus
systemic capillary leak syndrome
thoracic outlet syndrome
typhoid
This symptom has already been validated