Acute Tubular Necrosis

Question 1

What is acute tubular necrosis

Answer 1

Damage and death of epithelial cells lining the renal tubules

Question 2

Acute tubular necrosis is the leading cause of…

Answer 2

Acute kidney injury

Question 3

What causes acute tubular necrosis?

Answer 3

Damage as a result of either ischaemia or toxins…

Ischaemia:

• Hypovolaemia (dehydration, sepsis)
• Hypoperfusion (renal artery stenosis)

Toxins:
- Aminoglycosides, e.g. gentamicin (directly nephrotoxic)

Question 4

Is acute tubular necrosis reversible?

Answer 4

Yes - the tubular epithelial cells have the ability to regenerate which usually takes between 7 and 21 days

Question 5

What might you find on urinalysis in a patient with acute tubular necrosis?

Answer 5

• “Muddy brown casts” = pathognomonic finding specific to ATN
• Renal tubular epithelial cells

Question 6

Describe the management of acute tubular necrosis

Answer 6

Supportive management:

• IV fluids
• Stop nephrotoxic medications
• Treat complications, e.g. hyperkalaemia