Acute Tubular Necrosis

Question 1

Explain

Answer 1

Damage and death of the epithelial cells of the renal tubules.

Most common cause of AKI

Damage to the kidney cells occurs due to ischaemia or toxins.

Question 2

Is ATN reversible?

Answer 2

Yes, the epithelial cells have the ability to regenerate making acute tubular necrosis reversible.

It usually takes 7-21 days to recover from it.

Question 3

Causes of ATN

Answer 3

Seconary to hypoperfusion:

Shock
Sepsis
Dehydration

Direct damage from toxins:

Radiology contrast dye
Gentamicin
NSAIDs

Question 4

Main investigation to do in ATN

Answer 4

FBC

BP

U&Es

Urinalysis

Question 5

Urinalysis findings of ATN

Answer 5

Muddy brown casts which is pathognomonic for ATN.

There might also be renal tubular epithelial cells in the urine

Question 6

Management of ATN

Answer 6

Same as AKI

Supportive management

IV fluids

Stop and nephrotoxic drug

Treat complications

Escalate to dialysis if refractory