Acute Tubular Necrosis

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 Burns Burns are injuries to tissue that result from heat, electricity, radiation, or chemicals. Burns cause varying degrees of pain, blisters, swelling, and skin loss. Small, shallow burns may need... read more , serious bodywide infection (sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more ), and pancreatitis Overview of Pancreatitis Pancreatitis is inflammation of the pancreas. The pancreas is a leaf-shaped organ about 5 inches (about 13 centimeters) long. It is surrounded by the lower edge of the stomach and the first... read more .

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

Medications that commonly damage the kidneys include aminoglycoside antibiotics (such as gentamicin and tobramycin), amphotericin B (a medication 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 Radiographic contrast agents are substances used to distinguish between internal structures in medical imaging, such as various types of x-rays and magnetic resonance imaging (MRI). During imaging... 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.

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 medication 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.

Medications 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 may be required for people who do not respond to supportive care.

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.

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