Acute Tubular Necrosis

Question 1

What is it?

Answer 1

Acute tubular necrosis (ATN) is the most common cause of acute kidney injury (AKI) seen in clinical practice.

Necrosis of renal tubular epithelial cells severely affects the functioning of the kidney.

In the early stages ATN is reversible if the cause if removed.

Question 2

Causes

Answer 2

There are two main causes of ATN; ischaemia and nephrotoxins:

ISCHAEMIA
shock
sepsis

NEPHROTOXINS
aminoglycosides
myoglobin secondary to rhabdomyolysis
radiocontrast agents
lead

Question 3

Investigations

Answer 3

features of AKI: raised urea, creatinine, potassium

muddy brown casts in the urine

Histology: tubular epithelium necrosis: loss of nuclei and detachment of tubular cells from the basement membrane