Tubule effects

Tubular backleak plays a minor role in mild or non-oliguric forms of toxic or ischemic ARF. As the severity of renal ischemia increases, the contribution of tubular wall permeability to the suppression of glomerular filtration is enhanced. Immunoglobulin light-chain cast precipitation may complicate plasma cell dyscrasias and intraluminal pigments may play a role in rhabdomyolysis and hemoglobinuria, although the correlation between cast deposition and renal failure is weak. Tubular dilatation may be seen with intratubular precipitation of crystals (uric acid, oxalate, acyclovir, methotrexate, sulfonamides), as typically seen in the tumor lysis syndrome

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