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Acute Tubular Injury (ATI)

Muhammad I. Durrani, MS, DO, Samaresh Dasgupta, DO and Andrew Coppa, MS, DO Reviewed 05/2023
 


BASICS

DESCRIPTION

  • Acute tubular injury (ATI) (new nomenclature, for acute tubular necrosis) to define intrinsic renal damage due to ischemic, toxin mediated, or other insult to the kidney affecting th...

DIAGNOSIS

HISTORY

  • History of episode of relative hypoperfusion or IV contrast exposure

  • Review of current medications to evaluate for nephrotoxic agents and excessive dosing as well as drug-drug interact...

TREATMENT

GENERAL MEASURES

  • Identify and treat underlying causes, with diligence to avoid further kidney injury once identified (2).

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

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. 

DIET

Recommendations ...

REFERENCES

1
Moeckel GW. Pathologic perspectives on acute tubular injury assessment in the kidney biopsy. Semin Nephrol. 2018;38(1):21–30.
2
Subramaniam  RM, Suarez-Cuervo  C, Wils...

ADDITIONAL READING

Rahman  M, Shad  F, Smith  MC. Acute kidney injury: a guide to diagnosis and management. Am Fam Physician.  2012;86(7):631–639. [View Abstract on OvidMedli...

SEE ALSO

Algorithm: Acute Kidney Injury (Acute Renal Failure) 

CODES

ICD10

N17.0 Acute kidney failure with 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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