Acute tubular necrosis (ATN) is usually caused by a lack of oxygen to the kidney tissues (ischemia of the kidneys). It may also occur if the kidney cells are damaged by a poison or harmful substance.
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:
In most people, ATN is reversible. The goal of treatment is to prevent life-threatening complications of acute kidney failure.
Treatment focuses on preventing the excess buildup of fluids and wastes, while allowing the kidneys to heal. Patients should be watched closely for deterioration of kidney function.
Treatment can include:
Identifying and treating the underlying cause of the problem
Restricting fluid intake to a volume equal to the volume of urine produced
Restricting substances normally removed by the kidneys (such as protein, sodium, potassium) to minimize their buildup in the body
Taking medications to help control potassium levels in the bloodstream
Medicines taken by mouth or through an IV to help remove fluid from the body
Temporary 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.
To remove toxins that are dangerous to the kidneys
Total lack of urine production
Uncontrolled buildup of nitrogen waste products
How long symptoms last can vary. You may make less urine for a few days to 6 weeks or more. This may be followed by a period of high urine output. This occurs because the healed and newly functioning kidneys try to clear the body of fluid and waste.
One or two days after your urine amount rises, symptoms reduce and test results begin to return to normal.
Bleeding from the gastrointestinal tract
Chronic kidney disease and permanent kidney damage
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 as well as 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.
Clarkson MR, Friedewald JJ, Eustace JA, Rabb H. Acute kidney injury. In: Brenner BM, ed. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 29.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Herbert Y. Lin, MD, PHD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.