Necrosis - renal tubular; ATN; Necrosis - acute tubular
Acute tubular necrosis is a kidney disorder involving damage to the tubule cells of the kidneys, resulting in acute kidney failure.
Acute tubular necrosis (ATN) is caused by lack of oxygen to the kidney tissues (ischemia of the kidneys).
The internal structures of the kidney, particularly the tissues of the kidney tubule, become damaged or destroyed. ATN is one of the most common structural changes that can lead to acute renal failure.
ATN is one of the most common causes of kidney failure in hospitalized patients. Risks for acute tubular necrosis include:
Liver disease and kidney damage caused by diabetes (diabetic nephropathy) may make a person more susceptible to the condition.
ATN can be caused by:
Note: Other symptoms of acute kidney failure may also be present.
Examination usually indicates acute kidney failure. There may be signs of fluid overload, including abnormal sounds on listening to the heart and lungs with a stethoscope (auscultation).
Other signs include:
In most people, acute tubular necrosis is reversible. The goal of treatment is to prevent life-threatening complications of acute kidney failure during the time the lesion is present.
Treatment focuses on preventing the excess build-up of fluids and wastes, while allowing the kidneys to heal. Patents should be watched for deterioration of kidney function.
Treatment can include:
Dialysis can remove excess waste and fluids. This can make you feel better, and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is often lifesaving, especially if serum potassium is dangerously high.
Dialysis may be needed in the following cases:
The duration of symptoms varies. The decreased urine output phase may last from a few days to 6 weeks or more. This is occasionally followed by a period of high urine output, where the healed and newly functioning kidneys try to clear the body of fluid and wastes.
One or two days after urine output rises, symptoms reduce and laboratory values begin to return to normal.
Call your health care provider if your urine output decreases or stops, or if you develop other symptoms of acute tubular necrosis.
Promptly treating conditions that can lead to decreased blood flow and/or decreased oxygen to the kidneys can reduce the risk of acute tubular necrosis.
Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.
Control conditions such as diabetes, liver disorders, and cardiac disorders to reduce the risk of acute tubular necrosis.
Carefully monitor exposure to medications that can be toxic to the kidney. Have your blood levels of these medications checked regularly. Drink a lot of fluids after having any radiocontrast dyes to allow them to be removed from the body and reduce the risk of kidney damage.
Goldman L, Ausiello D. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007 Chapter 121
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