Acute tubular necrosis

Overview

Acute tubular necrosis is a variant of acute kidney injury resulting from damage to tubules by chemicals, contrast dyes, and decreased blood flow and oxygen supply to the kidneys. It ultimately leads to rapid reduction of kidney function.

What causes Acute tubular necrosis?

  • Acute tubular necrosis is caused by lack of blood supply (ischemia) and oxygenation to the kidneys. It is also caused by various medications such as aminoglycosides, amphotericin B, NSAIDs, and also caused by exposure to radiocontrast media (the dye used for x-ray and other radiographic studies)
  • The internal structures of the kidney, particularly the tissues of the kidney tubule, become damaged or destroyed. Acute tubular necrosis is one of the most common structural changes that can lead to acute kidney injury.

Who is at highest risk?

Acute tubular necrosis is one of the most common causes of kidney failure in hospitalized patients.

  • Recent major surgery
  • Septic shock or other forms of shock
  • Severe low blood pressure (hypotension)
  • Injury or trauma that damages the muscles
  • Blood transfusion reaction
  • Kidney damage caused by diabetes (diabetic nephropathy) may make a person more susceptible to the condition.

What are the symptoms of Acute tubular necrosis?

  • Decreased urine output or no urine output
  • General swelling, fluid retention
  • Drowsy, lethargic, hard to arouse
  • Nausea and vomiting
  • Excessive thirst
  • Decreased consciousness
  • Coma
  • Delirium or confusion

When to seek urgent medical care?

Call your health care provider if your urine output decreases or stops, or if you develop other symptoms of acute tubular necrosis.

Diagnosis

  • Examination may usually show signs and symptoms of acute kidney failure.
  • Laboratory findings include:
    • BUN and serum creatinine levels may increase
    • Fractional excretion of sodium levels are elevated
    • The kidney biopsy may show acute tubular necrosis.
    • Urinalysis may show muddy brown casts, epithelial casts, kidney tubular cells.
    • Urine sodium levels are elevated.
    • Urine specific gravity and osmolarity urine usually indicate diluted urine.

Treatment options

  • 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 the deterioration of kidney function.
  • Treatment can include:
    • Identifying and treating the underlying cause that is responsible for tubular damage.
    • Fluid intake may be restricted to the amount 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 body.
    • Dialysis can be helpful in removing nitrogenous waste and excess 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.

Where to find medical care for Acute tubular necrosis?

Ask our experts on Acute tubular necrosis

What to expect (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.

Possible complications

  • Hyperkalemia
  • Hyponatraemia
  • Metabolic acidosis
  • Hyperphosphatemia
  • Gastrointestinal loss of blood
  • Hypertension
  • Increased risk of infection

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.
  • 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.

Attribution

This article incorporates public domain material from Wikidoc and MedlinePlus. Please see licenses for further details.

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