Acute tubular necrosis

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.

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]Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting. Nat Rev Nephrol. 2018 Apr;14(4):217-30. http://www.ncbi.nlm.nih.gov/pubmed/29355173?tool=bestpractice.com [2]Abuelo JG. Normotensive ischemic acute renal failure. N Engl J Med. 2007 Aug 23;357(8):797-805. http://www.ncbi.nlm.nih.gov/pubmed/17715412?tool=bestpractice.com 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]Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Inter Suppl. 2012 Mar;2(1):1-138. https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf

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]Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012 Aug 25;380(9843):756-66. http://www.ncbi.nlm.nih.gov/pubmed/22617274?tool=bestpractice.com