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 .