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. 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
Key diagnostic factors
- oliguria or anuria
Other diagnostic factors
- poor oral intake and anorexia
- chronic kidney disease (CKD)
- chronic hypertension
- diabetes mellitus
- advanced age
- low-perfusion states
- major surgery
- exposure to nephrotoxic agents
- exposure to radiocontrast media
- exposure to endogenous toxins
1st investigations to order
- 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
- coagulation studies
- urinary myoglobin
Investigations to consider
- arterial blood gases (ABG)
- platelet aggregation studies
- inferior vena cava (IVC) diameter measured by ultrasound
- renal biopsy
- serum and urinary biomarkers
acute tubular necrosis (ATN)
- Prerenal azotemia
- Intrinsic renal azotemia
- KDIGO clinical practice guideline for acute kidney injury
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