Acute tubular necrosis
Acute tubular necrosis (ATN) is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure. The tubules are tiny ducts in the kidneys that help filter the blood when it passes through the kidneys.
Acute kidney failure
Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...
Read Article Now Book Mark ArticleCauses
ATN is often caused by a lack of blood flow and 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 kidney failure.
ATN is a common cause of kidney failure in people who are in the hospital. Risks for ATN include:
- Blood transfusion reaction
Blood transfusion reaction
A hemolytic transfusion reaction is a serious complication that can occur after a blood transfusion. The reaction occurs when the red blood cells th...
Read Article Now Book Mark Article - Injury or trauma that damages the muscles
- Low blood pressure (hypotension) that lasts longer than 30 minutes
- Recent major surgery
- Septic shock (serious condition that occurs when a body-wide infection leads to dangerously low blood pressure)
Septic shock
Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure.
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Liver disease and kidney damage caused by diabetes (diabetic nephropathy) may make a person more prone to develop ATN.
Diabetic nephropathy
Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic nephropathy.
Read Article Now Book Mark ArticleATN can also be caused by medicines that are toxic to the kidneys. These medicines include aminoglycoside antibiotics and the antifungal drug amphotericin.
Symptoms
Symptoms may include any of the following:
- Decreased consciousness, coma, delirium or confusion, drowsiness, and lethargy
Decreased consciousness
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
Read Article Now Book Mark ArticleDelirium
Delirium is sudden severe confusion due to rapid changes in brain function that can occur with physical or mental illness.
Read Article Now Book Mark ArticleConfusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark Article - Decreased urine output or no urine output
Decreased urine output
Decreased urine output means that you produce less urine than normal. Most adults make at least 500 milliliters of urine in 24 hours (a little over ...
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- Nausea, vomiting
Exams and Tests
Your health care provider will perform a physical exam. Your provider may hear abnormal sounds when listening to the heart and lungs with a stethoscope. This is due to too much fluid in the body.
Tests that may be done include:
- Blood urea nitrogen (BUN) and serum creatinine
Blood urea nitrogen (BUN)
BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. A test can be done to measure the amount of urea nitrogen ...
Read Article Now Book Mark Article - Fractional excretion of sodium
Fractional excretion of sodium
Fractional excretion of sodium is the amount of salt (sodium) that leaves the body through urine compared to the amount filtered and reabsorbed by th...
Read Article Now Book Mark Article - Kidney biopsy
Kidney biopsy
A kidney biopsy is the removal of a small piece of kidney tissue for examination.
Read Article Now Book Mark Article - Urinalysis
Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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Urine sodium
The sodium urine test measures the amount of sodium the urine. Sodium can also be measured in a blood sample.
Read Article Now Book Mark Article - Urine specific gravity and urine osmolarity
Urine specific gravity
Urine specific gravity is a laboratory test that shows the total concentration of all chemical particles in the urine.
Read Article Now Book Mark ArticleUrine osmolarity
The osmolality urine test measures the concentration of chemicals in urine. Osmolality in the blood can be measured using a blood test.
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Treatment
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 buildup of fluids and wastes, while allowing the kidneys to heal.
Treatment may include any of the following:
- Identifying and treating the underlying cause of the problem
- Restricting fluid intake
- Taking medicines to help control the potassium level in the blood
- 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 help improve your symptoms so that you feel better. It may also make kidney failure easier to control. Dialysis may not be necessary for all people, but is often lifesaving, especially if potassium is dangerously high.
Dialysis
Dialysis treats end-stage kidney disease also called kidney failure. It removes waste from your blood when your kidneys can no longer do their job. ...
Read Article Now Book Mark ArticlePotassium
This test measures the amount of potassium in the fluid portion (serum) of the blood. Potassium (K+) helps nerves and muscles communicate. It also ...
Read Article Now Book Mark ArticleDialysis may be needed in the following cases:
- Decreased mental status
- Fluid overload
- Increased potassium level
- Pericarditis (inflammation of the sac-like covering around the heart)
Pericarditis
Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.
Read Article Now Book Mark Article - Removal of toxins that are dangerous to the kidneys
- Total lack of urine production
- Uncontrolled buildup of nitrogen waste products
Outlook (Prognosis)
ATN can last for a few days to 6 weeks or more. This may be followed by 1 or 2 days of making an unusually large amount of urine as the kidneys recover. Kidney function often returns to normal, but there may be other serious problems and complications.
When to Contact a Medical Professional
Contact your provider if your urine output decreases or stops, or if you develop other symptoms of ATN.
Prevention
Promptly treating conditions that can lead to decreased blood flow as well as decreased oxygen to the kidneys can reduce the risk for ATN.
Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.
Diabetes, liver disorders, and heart problems need to be managed well to reduce the risk for ATN.
If you know you're taking medicine that can injure your kidneys, ask your provider about having your blood level of the medicine checked regularly.
Drink a lot of fluids after having any contrast dyes to allow them to be removed from the body and reduce the risk for kidney damage.
Reviewed By
Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Gunning S, Koyner JL. Acute tubular injury and acute tubular necrosis. In: Gilbert S, ed. National Kidney Foundation Primer on Kidney Diseases. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 32.
Weisbord SD, Palevsky PM. Prevention and management of acute kidney injury. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 29.