An intrinsic acute kidney injury caused by ischaemic 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.
Acute kidney injury (AKI) is a common syndrome with a wide variety of aetiologies and pathophysiological processes, characterised by a rapid decrease in renal excretory function over a period of minutes to days. 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.
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.
History and exam
- basic metabolic profile (including urea and creatinine)
- urea-to-creatinine ratio
- urine sodium concentration
- urine osmolality
- fractional excretion of sodium
- fractional excretion of urea
- urinalysis for sediment
- coagulation studies
- urinary myoglobin
Maria Jesus Lloret Cora, MD, MSc
MJLC declares that she has no competing interests.
Leonor Fayos de Arizon, MD
LFA declares that she has no competing interests.
Dr Maria Jesus Lloret Cora would like to gratefully acknowledge Dr Roser Torra, the previous contributor to this topic.
RT declares that she has no competing interests.
Ajay Kumar, MD, FACP
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
Chicago Medical School
Rosalind Franklin University
IM declares that he has no competing interests.
Robert Tompkins, MD
Department of Family Medicine
University of Texas Health Science Center
RT declares that he has no competing interests.
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