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Acute Tubular Necrosis by Krisha McCoy, MS

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.

The Kidneys

Causes

Acute tubular necrosis can be caused by:

Lack of oxygen to kidney tissues from problems such as surgical complications 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
Toxic chemicals:
- Crystals (uric acid, calcium phosphate)
- Myoglobin
- Hemaglobin

Symptoms

If you experience any of these symptoms, do not assume it is due to acute tubular necrosis. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Change in urine output
Dehydration

Diagnosis

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

Blood tests
- BUN
- creatinine
- electrolytes
- calcium
- magnesium
- phosphorus
- complete blood counts
Urine tests (urinalysis, urine sodium, urea, osmolarity)
Kidney biopsy
Your doctor may need detailed pictures of your kidney. These can be made with:

Treatment

Talk with your doctor about the best treatment plan for you. In addition to good nutritional support, treatment options include the following:

Dialysis

Dialysis , in which a machine does the work of your kidneys by purging waste from your body.

Medications

Certain medications (eg, furosemide, bumetanide, mannitol, fenoldopam, auriculin anaritide, and synthetic atrial natriuretic peptide) may reduce the need for dialysis in certain people with acute tubular necrosis.

Prevention

The following measures may help reduce your chances of developing acute tubular necrosis:

Take measures recommended by your doctor to prevent kidney damage caused by the dyes used in x-ray studies such as with the use of oral N-acetylcysteine or theophylline.
Take certain drugs when using medications such as aminoglycosides or cisplatin, which are associated with kidney damage.
Use calcium channel blockers after having a kidney transplant .

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.

Last reviewed October 2012 by Adrienne Carmack, MD

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