Acute Tubular Necrosis

  • Definition

    Acute tubular necrosis is damage to the tubule cells (tiny tube-shaped cells) in the kidney that results in acute kidney failure. This is a potentially serious condition that requires care from your doctor.
    Anatomy of the Kidney
    Glomerulonephritis
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  • Causes

    Acute tubular necrosis can be caused by:
    • Lack of oxygen to kidney tissues from problems such as blood clots, surgical complications , severe dehydration or hemorrhage (heavy bleeding)
    • Exposure to toxic materials such as antibiotics, x-ray dyes, or anesthetics
  • Risk Factors

    A risk factor is something that increases your chance for getting a disease or condition. Risk factors that increase your chance of developing acute tubular necrosis include:
    • Injury
    • Trauma (Injury or trauma that damages the muscles)
    • Surgery
    • Blood transfusion
    • Septic shock
    • Shock
    • Low blood pressure
    • Liver disease or damage
    • Drugs (aminoglycosides, amphotericin B, cyclosporine, tacrolimus)
    • X-ray dye
    • Blood transfusion reaction
    • Toxic chemicals: This list is things produced by the body, maybe we also need to discuss toxic chemicals from elsewhere
      • Crystals (uric acid, calcium phosphate)
      • Myoglobin
      • Hemaglobin
  • Symptoms

    If you experience any of these symptoms, do not assume it is due to acute tubular necrosis. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
    • Change in urine output
    • General swelling, fluid retention
    • Nausea, vomiting
    • Dehydration
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include the following:
  • Treatment

    Talk with your doctor about the best treatment plan for you. In addition to good nutritional support and fluid , treating underlying condition, dietary changes, treatment options include the following:
    Dialysis
    Dialysis , in which a machine does the work of your kidneys by purging waste from your body.
    Medications
    Certain medications (eg, furosemide, bumetanide, mannitol, fenoldopam, auriculin anaritide, and synthetic atrial natriuretic peptide) may reduce the need for dialysis in certain people with acute tubular necrosis.
  • Prevention

    The following measures may help reduce your chances of developing acute tubular necrosis:
    Promptly treating conditions that can lead to decreased blood flow as well as decreased oxygen to the kidneys
    • Take measures recommended by your doctor to prevent kidney damage caused by the dyes used in x-ray studies such as with the use of oral N-acetylcysteine or theophylline.
    • Mostly this is accomplished by increasing fluids
    • Take certain drugs when using medications such as aminoglycosides or cisplatin, which are associated with kidney damage. Not sure what this means. What I know or was able
    • to read indicates that using them less often and monitoring levels is how to do this. I don't know that there are drugs that can prevent this. I checked GRU's 1 and 2
    • Use calcium channel blockers after having a kidney transplant .
  • RESOURCES

    American Academy of Family Physicians http://familydoctor.org

    National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

    CANADIAN RESOURCES

    Canadian Institute for Health Information http://www.cihi.ca

    Kidney Foundation of Canada http://www.kidney.ca

    References

    Acute tubular necrosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated June 14, 2010. Accessed November 1, 2012.

    Choudhury D, Ahmed Z: Drug-associated renal dysfunction and injury. Nat Clin Pract Nephrol . 2006;2:80-91

    Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med . 2002;137:744-52.

    Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: epidemiology, diagnosis, and management. Chest . 2005;128:2847-2863.

    Musso CG, Liakopoulos V, Ioannidis I, et al. Acute renal failure in the elderly: particular characteristics. Int Urol Nephrol . 2006;38:787-93

    Tepel M, van der Giet M, Schwarzfeld C, et al. Prevention of radiographic-contrast reductions in renal function by acetylcysteine. N Engl J Med . 2000;343:1448-1457.

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