Causes
Acute tubular necrosis (ATN) is caused by lack of oxygen to the kidney tissues (ischemia of the kidneys), or by exposure to materials that are poisonous to the kidney (nephrotoxic agents).
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:
Keep reading...
Treatment
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:
- 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
Keep reading...
Other Names
Necrosis - renal tubular; ATN; Necrosis - acute tubular
Outlook (Prognosis)
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.
Prevention
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.
Exams and Tests
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:
Keep reading...
References
Goldman L, Ausiello D. Goldman: Cecil Medicine . 23rd ed. Philadelphia, Pa: Saunders; 2008.
