Acute Tubular Necrosis

Overview

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 medical care.

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 heavy bleeding
  • Exposure to toxic materials such as antibiotics, IV contrast material used for imaging, or anesthetics

Risk Factors

Factors that may increase your chance of acute tubular necrosis include:

  • Injury
  • Trauma
  • Surgery
  • Blood transfusion
  • Septic shock
  • Shock
  • Low blood pressure
  • Liver disease or damage
  • Certain medications, such as aminoglycosides, amphotericin B, cyclosporine, or tacrolimus
  • Injections of IV contrast material used for imaging studies, such as CT scans
  • Blood transfusion reaction
  • Exposure or build up of toxic chemicals, such as:
    • Crystals (uric acid, calcium phosphate)
    • Myoglobin
    • Hemoglobin

SymptomsandDiagnosis

Symptoms

Acute tubular necrosis may cause:

  • Change in urine output
  • General swelling, fluid retention
  • Nausea and vomiting
  • Dehydration

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids and tissues may be tested. This can be done with:

  • Blood tests
  • Urine tests
  • Kidney biopsy

Images may be taken of the kidneys and surrounding structures. This can be done with:

  • Ultrasound
  • CT scan
  • MRI scan

Treatments

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 options 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 removes wastes and returns it back to the body.

Medications

Certain medications may reduce the need for dialysis in some people.

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 tests that required injections of contrast.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

RESOURCES

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

National Institute of Diabetes and Digestive and Kidney Diseases  http://www.niddk.nih.gov 

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca 

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

References

Acute tubular necrosis. EBSCO DynaMed website. Available at:  http://www.ebscohost.com/dynamed . Updated February 12, 2016. Accessed June 1, 2016.

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

Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med. 2002;137(9):744-52.

Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: Epidemiology, diagnosis, and management. Chest. 2005;128(4):2847-2863.

Musso CG, Liakopoulos V, Ioannidis I, Eleftheriadis T, Stefanidis I. Acute renal failure in the elderly: Particular characteristics. Int Urol Nephrol. 2006;38(3-4):787-793.

Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast reductions in renal function by acetylcysteine. N Engl J Med. 2000;343(3):1448-1457.