St. Luke's Hospital
Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
Find a Physician Payment Options Locations & Directions
Follow us on: facebook twitter Mobile Email Page Email Page Print Page Print Page Increase Font Size Decrease Font Size Font Size
America's 50 Best Hospitals
Meet the Doctor
Spirit of Women
Community Health Needs Assessment
Home > Health Information

Multimedia Encyclopedia

    Print-Friendly
    Bookmarks

    Acute tubular necrosis

    Necrosis - renal tubular; ATN; Necrosis - acute tubular

    Acute tubular necrosis is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure.

    Causes

    Acute tubular necrosis (ATN) is usually caused by alack of oxygen to the kidney tissues (ischemia of the kidneys). It may also occur if the kidney cells are damaged by a poison or harmful substance.

    The internal structures of the kidney, particularly the tissues of the kidney tubule, become damaged or destroyed. ATN is one of the most common structural changes that can lead to acute renal failure.

    ATN is one of the most common causes of kidney failure in hospitalized patients. Risks for acute tubular necrosis include:

    • Blood transfusion reaction
    • Injury or trauma that damages the muscles
    • Low blood pressure (hypotension) that lasts longer than 30 minutes
    • Recent major surgery
    • Septic shock due to severe infection

    Liver disease and kidney damage caused by diabetes (diabetic nephropathy) may make a person more susceptible to the condition.

    ATN can also be caused by:

    • Dye (contrast) used for x-ray (radiology) studies
    • Medications that are toxic to the kidneys (such as aminoglycoside antibiotics or amphotericin)

    Symptoms

    • Decreased consciousness
      • Coma
      • Delirium or confusion
      • Drowsy, lethargic, hard to arouse
    • Decreased urine output or no urine output
    • General swelling, fluid retention
    • Nausea, vomiting

    Note: Other symptoms of acute kidney failure may also be present.

    Exams and Tests

    The doctor will perform a physical exam. Your doctor may hear abnormal sounds when listening to the heart and lungs with a stethoscope (auscultation). This is due to too much fluid in the body.

    Other tests that may be done include:

    • BUN and serum creatinine
    • Fractional excretion of sodium
    • Kidney biopsy
    • Urinalysis
    • Urine sodium
    • Urine specific gravity and osmolarity urine

    Treatment

    In most people, ATN is reversible. The goal of treatment is to prevent life-threatening complications of acute kidney failure.

    Treatment focuses on preventing the excess buildup of fluids and wastes, while allowing the kidneys to heal. Patients should be watched closely for deterioration of kidney function.

    Treatment can include:

    • Identifying and treating the underlying cause of the problem
    • Restricting fluid intake to a volume equal to the volume of urine produced
    • Restricting substances normally removed by the kidneys (such as protein, sodium, potassium) to minimize their buildup in the body
    • Taking medications to help control potassium levels in the bloodstream
    • Medicines taken by mouth or through an IV to help remove fluid from the body

    Temporary dialysis can remove excess waste and fluids. This can make you feel better, and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is often lifesaving, especially if serum potassium is dangerously high.

    Dialysis may be needed in the following cases:

    • Decreased mental status
    • Fluid overload
    • Increased potassium levels
    • Pericarditis
    • To remove toxins that are dangerous to the kidneys
    • Total lack of urine production
    • Uncontrolled buildup of nitrogen waste products

    Outlook (Prognosis)

    How long symptoms last can vary. You may make less urine for a few days to 6 weeks or more. This may be followed by a period of high urine output. This occurs because the healed and newly functioning kidneys try to clear the body of fluid and waste.

    One or two days after your urine amount rises, symptoms reduce and test results begin to return to normal.

    Possible Complications

    • Bleeding from the gastrointestinal tract
    • Chronic kidney disease and permanent kidney damage
    • High blood pressure
    • Increased risk of infection

    When to Contact a Medical Professional

    Call your health care provider if your urine output decreases or stops, or if you develop other symptoms of acute tubular necrosis.

    Prevention

    Promptly treating conditions that can lead to decreased blood flow as well asdecreased oxygen to the kidneys can reduce the risk of acute tubular necrosis.

    Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.

    Control conditions such as diabetes, liver disorders, and cardiac disorders to reduce the risk of acute tubular necrosis.

    Carefully monitor exposure to medications that can be toxic to the kidney. Have your blood levels of these medications checked regularly. Drink a lot of fluids after having any radiocontrast dyes to allow them to be removed from the body and reduce the risk of kidney damage.

    References

    Clarkson MR, Friedewald JJ, Eustace JA, Rabb H. Acute kidney injury. In: Brenner BM, ed. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 29.

    Molitoris BA. Acute kidney injury. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 121.

    BACK TO TOP

    • Kidney anatomy

      illustration

    • Kidney - blood and urine...

      illustration

      • Kidney anatomy

        illustration

      • Kidney - blood and urine...

        illustration

      A Closer Look

        Self Care

          Tests for Acute tubular necrosis

          Review Date: 9/20/2011

          Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Herbert Y. Lin, MD, PHD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
          adam.com

          A.D.A.M. content is best viewed in IE9 or above, Fire Fox and chrome browser.


          Back  |  Top
          About Us
          Contact Us
          History
          Mission
          Locations & Directions
          Quality Reports
          Annual Reports
          Honors & Awards
          Community Health Needs
          Assessment

          Newsroom
          Services
          Brain & Spine
          Cancer
          Heart
          Maternity
          Orthopedics
          Pulmonary
          Sleep Medicine
          Urgent Care
          Women's Services
          All Services
          Patients & Visitors
          Locations & Directions
          Find a Physician
          Tour St. Luke's
          Patient & Visitor Information
          Contact Us
          Payment Options
          Financial Assistance
          Send a Card
          Mammogram Appointments
          Health Tools
          My Personal Health
          mystlukes
          Spirit of Women
          Health Information & Tools
          Clinical Trials
          Health Risk Assessments
          Employer Programs -
          Passport to Wellness

          Classes & Events
          Classes & Events
          Spirit of Women
          Donate & Volunteer
          Giving Opportunities
          Volunteer
          Physicians & Employees
          For Physicians
          Remote Access
          Medical Residency Information
          Pharmacy Residency Information
          Physician CPOE Training
          Careers
          Careers
          St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
          Copyright © St. Luke's Hospital Website Terms and Conditions  |  Privacy Policy  |  Patient Notice of Privacy Policies PDF Sitemap St. Luke's Mobile