Acute tubular necrosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Última revisão: 12 Aug 2025

Última atualização: 29 Sep 2020

An intrinsic acute kidney injury caused by ischemic or nephrotoxic injury to renal tubular epithelial cells, which results in tubular dysfunction or detachment from the basement membrane.

A history of hypotension, fluid depletion, or exposure to nephrotoxic agents is usually present.

In otherwise healthy individuals, when the underlying insult is corrected, the patient frequently has a good outcome with complete renal recovery.

There is no specific therapy for acute tubular necrosis apart from supportive care.

Definição

Acute kidney injury (AKI) is a common syndrome with a wide variety of etiologies and pathophysiologic processes, characterized by a rapid decrease in renal excretory function over a period of minutes to days.[1][2] According to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI severity is classified into three stages depending on the serum creatinine level or the extent of oliguria.[3]

Acute tubular necrosis (ATN) is an intrinsic AKI that follows a condition of severe and persistent hypoperfusion or toxic injury of epithelial cells causing detachment of the basement membrane and tubular dysfunction.[4]

História e exame físico

Principais fatores diagnósticos

oliguria or anuria
hypotension
tachycardia

Detalhes completos

Outros fatores diagnósticos

poor oral intake and anorexia
malaise
thirst
dizziness
orthopnea/dyspnea
edema

Detalhes completos

Fatores de risco

chronic kidney disease (CKD)
chronic hypertension
diabetes mellitus
advanced age
low-perfusion states
sepsis
major surgery
exposure to nephrotoxic agents
exposure to radiocontrast media
exposure to endogenous toxins

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

basic metabolic profile (including BUN and creatinine)
BUN-to-creatinine ratio
urine sodium concentration
urine osmolality
fractional excretion of sodium
fractional excretion of BUN
urinalysis for sediment
CBC
coagulation studies
urinary myoglobin

Detalhes completos

Investigações a serem consideradas

arterial blood gases (ABG)
platelet aggregation studies
ultrasound
ECG
inferior vena cava (IVC) diameter measured by ultrasound
renal biopsy
serum and urinary biomarkers

Detalhes completos

Algoritmo de tratamento

AGUDA

acute tubular necrosis (ATN)

Colaboradores

Autores

Maria Jesus Lloret Cora, MD, MSc

Consulting Staff

Nephrology Department

Fundació Puigvert

Barcelona

Spain

Declarações

MJLC declares that she has no competing interests.

Leonor Fayos de Arizon, MD

Resident

Nephrology Department

Fundació Puigvert

Barcelona

Spain

Declarações

LFA declares that she has no competing interests.

Agradecimentos

Dr Maria Jesus Lloret Cora would like to gratefully acknowledge Dr Roser Torra, the previous contributor to this topic.

Declarações

RT declares that she has no competing interests.

Revisores

Ajay Kumar, MD, FACP

Medical Director

Blood Management

Cleveland Clinic

Cleveland

Declarações

AK has received a fee for speaking about perioperative blood management from Ortho-Biotech and has also received reimbursement from medscape.com for the education webcast of the same presentation.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

Declarações

IM declares that he has no competing interests.

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

Declarações

RT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: epidemiology, diagnosis, and management. Chest. 2005 Oct;128(4):2847-63. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Prerenal azotemia
- Intrinsic renal azotemia
Mais Diagnósticos diferenciais
Diretrizes
- KDIGO clinical practice guideline for acute kidney injury
Mais Diretrizes
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Acute tubular necrosis

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

acute tubular necrosis (ATN)

Colaboradores

Autores

Maria Jesus Lloret Cora, MD, MSc

Declarações

Leonor Fayos de Arizon, MD

Declarações

Agradecimentos

Declarações

Revisores

Ajay Kumar, MD, FACP

Declarações

Irfan Moinuddin, MD

Declarações

Robert Tompkins, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

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