Acute Tubular Injury (ATI)

Muhammad Durrani, DO, MS and Samaresh Dasgupta, DO, MHA, FACEP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Acute tubular injury (ATI) is the new nomenclature, now commonly used in place of acute tubular necrosis to define a sudden reduction in renal functioning, resulting from a myriad of...

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

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

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

PROGNOSIS

  • All-cause m...

REFERENCES

Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med.  2002;137(9):744–752.  [View Abstract]
Basile DP, Anderson MD, Sutton TA. Pathophysiology of a...

ADDITIONAL READING

  • Gilbert SJ, Weiner DE, Bomback AS, et al. National Kidney Foundation's primer on kidney diseases. 7th ed. Philadelphia, PA: Elsevier; 2017.

  • Rahman M, Shad F, Smith MC. Acute kidney...

SEE ALSO

Algorithm: 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) 

CLINICAL PEARLS

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

  • No gold standard for diagnosis; clinicians must use data from the patient's histo...

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