Acute tubular necrosis

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Kidney anatomy

Kidney - blood and urine flow

Necrosis - renal tubular; ATN; Necrosis - acute tubular

In most people, acute tubular necrosis is reversible. The goal of treatment is to prevent life-threatening complications of acute renal failure during the time the lesion is present.

Treatment focuses on preventing the excess accumulation of fluids and wastes while allowing the kidneys to heal. Observation for deterioration of kidney function should be ongoing.

Fluid intake may be restricted to a volume equal to the volume of urine produced.

The intake of substances that are normally excreted by the kidney may be restricted to minimize their buildup in the body. This may include a diet high in carbohydrates, low in protein, reduced sodium, and reduced potassium.

The underlying cause must be identified and treated.

Diuretics (water pills) may be used to increase fluid excretion from the kidney. Medications may be given to control potassium levels in the bloodstream.

Dialysis may be used to remove excess waste and fluids. This often makes the person feel better, and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is frequently lifesaving, particularly if serum potassium is dangerously high.

Decreased mental status, pericarditis, increased potassium levels, total lack of urine production, fluid overload, and uncontrolled accumulation of nitrogen waste products are common indications for dialysis.

The duration of symptoms of ATN is variable. The decreased urine output phase may last from a few days to 6 weeks or more. This is occasionally followed by a period of high urine output, where the healed and newly functioning kidneys attempt to clear the body of fluid and wastes. One or two days after urine output rises, symptoms reduce and laboratory values begin to return to normal.

• Increased risk of infection
• Gastrointestinal loss of blood
• Chronic renal failure
• End-stage renal disease
• Hypertension

Call your health care provider if urine output decreases or stops, or if other symptoms suggestive of acute tubular necrosis develop.

Review Date: 12/09/2005
Reviewed By: Colm C. Magee, MD, MPH, Medical Director, Renal Transplant, Brigham & Women's Hospital, and Assistant Professor, Harvard Medical School, Boston, MA. Review provided by VeriMed Healthcare Network.