The Rise and Fall of Acute Tubular Necrosis – An exercise in medical semiotics


Ideas require words for their expression and words are sharp instruments, potentially dangerous if used unwisely. Inappropriate selection of words to convey a concept can powerfully inhibit progress that otherwise may have flowed unrestrained had superior linguistics prevailed. The syndrome associated with systemic manifestations in patients who experience rapid increases in serum creatinine concentrations provides an excellent example of this. Observers have used many terms over centuries to describe this condition, with one of them, ‘acute tubular necrosis’ (commonly ‘ATN’), providing a particular example.

Graham Bull, A.M. Joekes and K.G. Lowe introduced this phrase in 1950 to escape from previous inadequate terminology bedevilling a then recently redescribed condition. They envisaged a unifying pathogenetic mechanism that would underlie all cases. Enthusiastic to improve therapy, they relied heavily on observations made by others to justify their novel terminology. Many adopted it: it gained huge traction and current textbooks continue to employ it. Yet as early as 1962 investigators such as Ernest Finckh had demonstrated quite unequivocally that it seriously failed the task assigned to it. Other unsatisfactory terms such as ‘acute renal failure’ of 1951 have come and persisted somewhat uncomfortably alongside it until challenged by ‘acute kidney injury’ in 2007, yet even this has weaknesses.

The present communication reviews the linguistic history of this field over the past 75 years, the backgrounds of some of the people involved, and the importance to the scientific enterprise of care in choice of vocabulary.

KEY WORDS: Acute tubular necrosis, Acute kidney injury, Acute renal failure


Ci spiace, ma questo articolo è disponibile soltanto in Inglese Americano.


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