Acute Tubular Necrosis (ATN)

Aaron L. Moody, MD, LT, MC, USN and Michael J. Arnold, MD, CDR, MC, USN Reviewed 06/2017
 


BASICS

DESCRIPTION

  • Tubular epithelial damage from external insults; damage to interstitium, vasculature, and glomeruli also documented in cases of ATN (1)

  • Seen in clinical scenario where sufficient rena...

DIAGNOSIS

HISTORY

  • High clinical suspicion is paramount for prompt diagnosis.

  • History of episode of relative hypoperfusion or IV contrast exposure

  • Review of current medications to evaluate for nephrotoxic...

TREATMENT

GENERAL MEASURES

  • Identify and treat underlying causes, with clinical diligence to avoid further kidney injury once identified (5).

  • Discontinue any nephrotoxic medications, correct hypovolemia,...

ONGOING CARE

FOLLOWUP RECOMMENDATIONS

MONITORING

Follow BUN/Cr, monitor UO, and evaluate hemodynamics. Once AKI resolves, UO usually returns and BUN/Cr returns to baseline. 

PROGNOSIS

  • All-cause mortality ...

REFERENCES

Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med.  2002;137:744–752. [View Abstract on OvidInsights]
Kidney Disease: Improving Global Outcomes (...

ADDITIONAL READING

Rahman M, Shad F, Smith MC. Acute kidney injury: a guide to diagnosis and management. Am Fam Physician  2012;86(8):631–639. [View Abstract on OvidInsights] 

SEE ALSO

Acute kidney injury (Acute Renal Failure) 

CODES

ICD10

N17.0 Acute kidney failure with tubular necrosis 

ICD9

584.5 Acute kidney failure with lesion of tubular necrosis 

SNOMED

35455006 Acute tubular necrosis (disorder) 

PEARLS

  • ATN has high mortality—early recognition as well as prevention of ATN are critical to improve survival.

  • No gold standard for diagnosis; clinicians must use data from the patient’s history, physi...

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