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.
The Kidneys
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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
Last Updated: 10/31/2012
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