Acute Tubular Necrosis

Overview

What is acute tubular necrosis?

Acute tubular necrosis is a condition that causes the lack of oxygen and blood flow to the kidneys, damaging them. Tube-shaped structures in the kidneys, called tubules, filter out waste products and fluid. These structures are damaged in acute tubular necrosis.

When this happens acute kidney failure may occur, with electrolytes and fluids increasing in the body, possibly past safe levels.

Symptoms and Causes

What causes acute tubular necrosis?

The most frequent causes of acute tubular necrosis are a stroke or a heart attack, conditions that reduce oxygen to the kidneys.

Chemicals can also damage the tubules. These include X-ray contrast dye, anesthesia drugs, antibiotics and other toxic chemicals.

What are the risk factors for developing acute tubular necrosis?

Risk factors for acute tubular necrosis include situations where blood flow is cut off or reduced (as with blood clots), extended periods of low blood pressure or shock.

Blood loss from surgery and trauma can also lead to acute tubular necrosis. Other risk factors are muscle damage and liver disease.

What are the symptoms of acute tubular necrosis?

Symptoms of acute tubular necrosis include:

  • A small amount of urine output.
  • Swelling and fluid retention.
  • Nausea and vomiting.
  • Trouble waking up/drowsiness.
  • Feeling sluggish.
  • Confusion.

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Diagnosis and Tests

What tests are used to diagnose acute tubular necrosis?

Several tests can be used to diagnose acute renal failure. These include blood waste products such as blood urea nitrogen (BUN), creatinine and electrolyte levels such as plasma potassium. The accumulation of these substances in the blood indicate that the kidneys are not working properly.

Acute tubular necrosis is usually diagnosed by a nephrologist (kidney specialist). The diagnosis is mainly clinical but can be guided by microscopic examination of your urine. A biopsy of the kidney tissue can be done in certain cases, especially when the diagnosis is uncertain.

Management and Treatment

How is acute tubular necrosis treated?

Treating the underlying cause is crucial in order to allow the kidneys to recover. While the kidneys can often self-heal, you may be required to follow some dietary restrictions that include limiting fluid, sodium and potassium intake. This prevents the build-up of those substances while the kidneys are recovering. Diuretics (drugs to increase urination) and potassium-controlling medications may be prescribed.

Dialysis may be needed until the kidneys improve

Prevention

Can acute tubular necrosis be prevented?

Maintaining blood flow and oxygen to the kidneys can reduce the chance of developing acute tubular necrosis.

If a test with contrast dye is needed, drink a lot of water beforehand and afterwards.

Make sure your blood has been cross-matched before you receive a transfusion.

Work with your doctor to control the diseases that can damage the kidneys, such as high blood pressure, diabetes, liver disease and heart disease.

Avoid over-the-counter anti-inflammatory medications such as naproxen sodium and ibuprofen, especially if you have kidney disease.

Outlook / Prognosis

What is the outlook for someone with acute tubular necrosis?

Acute tubular necrosis can last for a few days or as long as several weeks. For relatively healthy people, the condition can be reversible. For those with other health conditions, recovery may take longer and may not be complete.

Last reviewed by a Cleveland Clinic medical professional on 12/11/2020.

References

  • Merck Manual. Acute Tubular Necrosis. (https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/kidney-filtering-disorders/acute-tubular-necrosis) Accessed 12/23/2020.
  • Hanif MO, Bali A, Ramphul K. Acute Renal Tubular Necrosis. (https://www.ncbi.nlm.nih.gov/books/NBK507815/) [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Accessed 12/23/2020.
  • Journal of the American Society of Nephrology. Acute Tubular Necrosis is a syndrome of Physiologic and Pathologic Dissociation. (https://jasn.asnjournals.org/content/19/5/871.full) Accessed 12/23/2020.

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