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Acute Tubular Necrosis


Frank O'Brien

, MD, Washington University in St. Louis

Full review/revision Jul 2021 | Modified Sep 2022
Topic Resources

Acute tubular necrosis is kidney injury caused by damage to the kidney tubule cells (kidney cells that reabsorb fluid and minerals from urine as it forms).

  • Common causes are low blood flow to the kidneys (such as caused by low blood pressure), drugs that damage the kidneys, and severe bodywide infections.

  • People have no symptoms unless kidney injury is severe.

  • Diagnosis is based mainly on the results of laboratory tests.

  • Treatment is directed at the cause, for example, stopping drugs that are damaging the kidneys, giving intravenous fluids to raise blood pressure, and giving antibiotics to treat infection.

Injury to the kidney tubule cells harms the ability of the kidneys to filter the blood. Thus, waste products such as urea and creatinine build up in the bloodstream.

The Nephrons, Glomeruli, and Tubules


Acute tubular necrosis usually develops only in people who are seriously ill and in the hospital. The most common causes are

The most common causes of low blood pressure leading to acute tubular necrosis are significant blood loss (due to injury or major surgery), serious burns, serious bodywide infection (sepsis), and pancreatitis.

Sepsis also can directly damage kidney cells, which worsens the effects of the low blood pressure caused by sepsis.

Drugs that commonly damage the kidneys include aminoglycoside antibiotics (such as gentamicin and tobramycin), amphotericin B (a drug used to treat severe, bodywide fungal infections), colistimethate (an antibiotic used to treat infections that develop in people hospitalized for another disorder), vancomycin (an antibiotic used to treat infections that are resistant to other antibiotics), and nonsteroidal anti-inflammatory drugs (NSAIDs). Aminoglycosides are more likely to be a cause among people who are older, have had major surgery, or have severe disorders of the liver, gallbladder, or bile ducts. Rarely, exposure to a contrast agent during an imaging procedure can cause kidney damage (contrast nephropathy Radiopaque Contrast Agents During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail. Contrast agents include Radiopaque contrast agents... read more ).

Acute tubular necrosis is more likely to develop in people who are older, are critically ill, or have underlying kidney disorders, diabetes, or both.


People with acute tubular necrosis usually have no symptoms. However, if the condition is severe, kidney failure Overview of Kidney Failure Kidney failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Kidney failure has many possible causes. Some lead to a rapid decline in kidney function... read more (loss of most kidney function) develops and people's urine output drops below normal. If kidney failure becomes severe, people may have nausea and vomiting, become weak, develop involuntary muscle spasms, and become confused.


  • Blood and urine tests

Doctors usually first suspect the disorder when blood tests show signs of kidney injury in people who have been exposed to a possible trigger, such as major surgery, an episode of low blood pressure, or a drug that can damage the kidneys. Similar findings can occur in people who are dehydrated, so doctors use other blood tests and urine tests to diagnose acute tubular necrosis.


Outcome depends on correction of the disorder that caused acute tubular necrosis. If that disorder responds rapidly to treatment, kidney function usually returns to normal in 1 to 3 weeks. Prognosis is usually better if people's urine volume exceeds 400 mL (about 13.5 ounces) every 24 hours. People who are more seriously ill, especially those who require care in an intensive care unit, have a higher risk of death.


  • Supportive care

Drugs that are damaging to the kidneys are stopped. Doctors also give intravenous fluids as needed to maintain a normal blood flow to the kidneys. Infections and other underlying disorders are treated. Dialysis Dialysis Dialysis is an artificial process for removing waste products and excess fluids from the body, a process that is needed when the kidneys are not functioning properly. There are a number of reasons... read more Dialysis may be required for people who do not respond to supportive care.


When a person is very ill, doctors give intravenous fluids and sometimes drugs to maintain blood pressure to try to maintain normal blood flow to the kidneys. Drugs that are damaging to the kidneys are avoided whenever possible. If such drugs are necessary, kidney function is closely monitored. In people with diabetes, blood sugar levels are controlled.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Aluvea , BP-50% Urea , BP-K50, Carmol, CEM-Urea, Cerovel, DermacinRx Urea, Epimide-50, Gord Urea, Gordons Urea, Hydro 35 , Hydro 40, Kerafoam, Kerafoam 42, Keralac, Keralac Nailstik, Keratol, Keratol Plus, Kerol, Kerol AD, Kerol ZX, Latrix, Mectalyte, Nutraplus, RE Urea 40, RE Urea 50 , Rea Lo, Remeven, RE-U40, RYNODERM , U40, U-Kera, Ultra Mide 25, Ultralytic-2, Umecta, Umecta Nail Film, URALISS, Uramaxin , Uramaxin GT, Urea, Ureacin-10, Ureacin-20, Urealac , Ureaphil, Uredeb, URE-K , Uremez-40, Ure-Na, Uresol, Utopic, Vanamide, Xurea, X-VIATE
Garamycin, Genoptic, Genoptic SOP, Gentacidin, Gentafair, Gentak , Gentasol, Ocu-Mycin
Amphocin, Fungizone
Vancocin, Vancocin Powder, VANCOSOL
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