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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 medical care.
    Anatomy of the Kidney
    Copyright © Nucleus Medical Media, Inc.
  • 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 heavy bleeding
    • Exposure to toxic materials such as antibiotics, x-ray dyes, or anesthetics
  • Risk Factors

    Factors that may increase your chance of acute tubular necrosis include:
    • Injury
    • Trauma
    • Surgery
    • Blood transfusion
    • Septic shock
    • Shock
    • Low blood pressure
    • Liver disease or damage
    • Certain medications, such as aminoglycosides, amphotericin B, cyclosporine, or tacrolimus
    • X-ray dye
    • Blood transfusion reaction
    • Exposure or build up of toxic chemicals, such as:
      • Crystals (uric acid, calcium phosphate)
      • Myoglobin
      • Hemoglobin
  • Symptoms

    Acute tubular necrosis may cause:
    • 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:
    • Blood tests
    • Urine tests
    • Kidney biopsy
    Imaging tests evaluate the kidneys and surrounding structures. These may include:
  • Treatment

    Talk with your doctor about the best treatment plan for you. Treatment will focus on treating the conditions that are causing damage. Good nutrition and proper fluid intake will also help reduce stress on the kidneys during recovery. Treatment options may also include:
    Dialysis is a process that uses a machine to assist or take over the work of your kidneys. The blood flows from catheters to a machine that removes wastes and returns it back to the body.
    Certain medications may reduce the need for dialysis in some people.
  • Prevention

    Acute tubular necrosis is sometimes the result of an accident. If you have kidney disease or a history of kidney problems, follow your doctor's instructions after surgical procedures or imaging test that required contrast dyes.

    Family Doctor—American Academy of Family Physicians

    National Institute of Diabetes and Digestive and Kidney Diseases


    Health Canada

    Kidney Foundation of Canada


    Acute tubular necrosis. EBSCO DynaMed website. Available at: Updated June 14, 2010. Accessed November 1, 2012.

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

    Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med. 2002;137(9):744-52.

    Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: Epidemiology, diagnosis, and management. Chest. 2005;128(4):2847-2863.

    Musso CG, Liakopoulos V, Ioannidis I, Eleftheriadis T, Stefanidis I. Acute renal failure in the elderly: Particular characteristics. Int Urol Nephrol. 2006;38(3-4):787-793.

    Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast reductions in renal function by acetylcysteine. N Engl J Med. 2000;343(3):1448-1457.

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