Acute Tubular Necrosis

Definition

Acute tubular necrosis is damage to the tubule cells (tiny tube-shaped cells) in the kidney that results in acute kidney failure. This is a potentially serious condition that requires care from your doctor.
Anatomy of the Kidney
Glomerulonephritis
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Causes

Acute tubular necrosis can be caused by:
  • Lack of oxygen to kidney tissues from problems such as blood clots, surgical complications, severe dehydration or hemorrhage (heavy bleeding)
  • Exposure to toxic materials such as antibiotics, x-ray dyes, or anesthetics

Risk Factors

A risk factor is something that increases your chance for getting a disease or condition. Risk factors that increase your chance of developing acute tubular necrosis include:
  • Injury
  • Trauma
  • Surgery
  • Blood transfusion
  • Septic shock
  • Shock
  • Low blood pressure
  • Liver disease or damage
  • Drugs (aminoglycosides, amphotericin B, cyclosporine, tacrolimus)
  • X-ray dye
  • Blood transfusion reaction
  • Exposure or build up of toxic chemicals such as:
    • Crystals (uric acid, calcium phosphate)
    • Myoglobin
    • Hemaglobin

Symptoms

Symptoms may include:
  • Change in urine output
  • General swelling, fluid retention
  • Nausea, vomiting
  • Dehydration

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include the following:

Treatment

Talk with your doctor about the best treatment plan for you. Treatment will focus on treating the conditions that are causing damage. Good nutrition and proper fluid intake will also help reduce stress on the kidneys during recovery. Treatment optionas may also include:

Dialysis

Dialysis is a process that uses a machine to assist or take over the work of your kidneys. The blood flows from catheters to a machine that can remove harmful substances, then back to your body.

Medications

Certain medications may reduce the need for dialysis in certain people with acute tubular necrosis.

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Prevention

Acute tubular necrosis is sometimes the result of an accident. If you have kidney disease or a history of kidney problems, follow your doctor's instructions after surgical procedures or imaging test that required contrast dyes.

RESOURCES

American Academy of Family Physicians
http://familydoctor.org

National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov

CANADIAN RESOURCES

Canadian Institute for Health Information
http://www.cihi.ca

Kidney Foundation of Canada
http://www.kidney.ca

References

Acute tubular necrosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 14, 2010. Accessed November 1, 2012.

Choudhury D, Ahmed Z: Drug-associated renal dysfunction and injury. Nat Clin Pract Nephrol . 2006;2:80-91

Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med . 2002;137:744-52.

Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: epidemiology, diagnosis, and management. Chest . 2005;128:2847-2863.

Musso CG, Liakopoulos V, Ioannidis I, et al. Acute renal failure in the elderly: particular characteristics. Int Urol Nephrol . 2006;38:787-93

Tepel M, van der Giet M, Schwarzfeld C, et al. Prevention of radiographic-contrast reductions in renal function by acetylcysteine. N Engl J Med . 2000;343:1448-1457.

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