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Acute Tubular Injury (ATI)

Muhammad I. Durrani, MS, DO and Samaresh Dasgupta, FACEP, MHA, DO Reviewed 06/2021
 


BASICS

DESCRIPTION

  • Acute tubular injury (ATI) is the new nomenclature, now commonly used in place of acute tubular necrosis to define intrinsic renal failure due to ischemic, toxin mediated, or other i...

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 diligence to avoid further kidney injury once identified (7).

  • 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. 

PROGNOSIS

  • All-cause m...

REFERENCES

1
Moeckel GW. Pathologic perspectives on acute tubular injury assessment in the kidney biopsy. Semin Nephrol. 2018;38(1):21-30.
2
Waikar SS, Liu KD, Chertow GM. Diagnosis, epidemiology and out...

ADDITIONAL READING

  • Gilbert  SJ, Weiner  DE, Bomback  AS, et al. National Kidney Foundation Primer on Kidney Diseases. 7th ed. Philadelphia, PA: Elsevier; 2017. [View Abstr...

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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