Acute tubular necrosis is damage to the tubule cells (tiny tube-shaped cells) in the kidney that results in kidney failure. This is a potentially serious condition that requires care from your doctor.
Causes
Acute tubular necrosis can be caused by:
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Lack of oxygen to kidney tissues (eg, surgical complications, hemorrhage)
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Exposure to toxic materials (eg, antibiotics, x-ray dyes, anesthetics)
Risk Factors
A risk factor is something that increases your chance for getting a disease or condition. The following risk factors increase your chance of developing acute tubular necrosis. If you have any of these risk factors, tell your doctor:
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Injury
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Trauma
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Surgery
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Blood transfusion
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Septic shock
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Shock
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Low blood pressure
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Liver disease or damage
Symptoms
If you experience any of these symptoms do not assume it is due to acute tubular necrosis. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
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Change in urine output
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Dehydration
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:
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Blood Tests
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Urine Tests
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Kidney Biopsy–removal of a sample of kidney tissue for testing (rarely needed)
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Ultrasound–a test that uses sound waves to examine the kidney
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Computed Tomography (CT Scan)–a type of x-ray that uses a computer to make pictures of structures inside the kidney
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Magnetic Resonance Imaging (MRI)–a test that uses magnetic waves to make pictures of structures inside the kidney
Treatment
Talk with your doctor about the best treatment plan for you. In addition to good nutritional support, treatment options include the following:
Dialysis
Dialysis, in which a machine does the work of your kidneys by purging waste from your body, may be needed in some cases of acute tubular necrosis.
Medications
Certain medications (eg, furosemide, mannitol, fenoldpam, auriculin anaritide, and synthethic atrial natriuretic peptide) may reduce the need for dialysis in certain people with acute tubular necrosis.
Prevention
The following measures may help reduce your chances of developing acute tubular necrosis:
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Take measures recommended by your doctor to prevent kidney damage caused by the dyes used in x-ray studies such as with the use of oral N-acetylcysteine or theophylline.
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Take certain drugs when using the medication cisplatin, which is associated with kidney damage.
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Use calcium channel blockers after having a kidney transplant.
RESOURCES:
American Academy of Family Physicians
http://familydoctor.org
National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov
CANADIAN RESOURCES:
Canadian Institute for Health Information
http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e
Kidney Foundation of Canada
http://www.kidney.ab.ca
References:
Acute tubular necrosis. DynaMed website. Available at: http://dynamed101.epnet.com/Detail.aspx?id=113848. Accessed December 3, 2006.
Acute tubular necrosis. Emedicine website. Available at: http://www.emedicine.com/med/topic39.htm. Accessed December 3, 2006.
Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med . 2002;137:744-52.
Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: epidemiology, diagnosis, and management. Chest. 2005;128:2847-63.
Tepel M, van der Giet M, Schwarzfeld C, et al. Prevention of radiographic-contrast reductions in renal function by acetylcysteine. N Engl J Med. 2000;343:1448-57.
