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Acute tubular necrosis
Alternative namesNecrosis - renal tubular; ATN; Necrosis - acute tubular
DefinitionAcute tubular necrosis is a kidney disorder involving damage to the renal tubule cells, resulting in acute kidney failure .
Causes, incidence, and risk factors
Acute tubular necrosis (ATN) is caused by ischemia of the kidneys (lack of oxygen to the tissues), 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 associated with the development of acute renal failure.
Any condition that causes a reduction in the amount of blood being pumped by the heart may cause ATN. Liver disease and damage caused by diabetes mellitus ( diabetic nephropathy ) may make a person more susceptible to the condition.
ATN can be caused by:
Signs and testsExamination usually indicates acute renal failure. There may be signs of fluid overload, including abnormal sounds on listening to the heart and lungs with a stethoscope ( auscultation ).
This disease may also alter the results of the following tests:
In most people, acute tubular necrosis is a reversible lesion. The goal of treatment is to prevent life-threatening complications of acute renal failure during the time the lesion is present.
Decreased mental status, pericarditis , increased potassium levels, total lack of urine production, fluid overload, and uncontrolled accumulation of nitrogen waste products are common indications for dialysis.
Expectations (prognosis)The duration of symptoms of ATN is variable. 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 refunctioning kidneys attempt 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.
Calling your health care providerCall your health care provider if urine output decreases or stops, or if other symptoms suggestive of acute tubular necrosis develop.
PreventionPrompt treatment of conditions that can result in decreased blood flow and/or decreased oxygenation of the kidneys may reduce the risk of acute tubular necrosis.
Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.
Disorders such as diabetes, liver disorders, or cardiac disorders must be controlled as much as possible to reduce the risk of ATN.
Exposure to medications that can be toxic to the kidney should be carefully monitored. Serum levels of the medication may be checked regularly. Adequate hydration after radiocontrast dyes may allow their excretion and reduce the risk of kidney damage.
Update Date: 1/19/2004Irfan A. Agha, M.D., Department of Medicine, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT