Acute tubular necrosis is a kidney disorder involving damage to the renal tubule cells, resulting in acute kidney failure.

Acute tubular necrosis (ATN) is caused by ischemia of the kidneys (lack of oxygen to the kidney tissues), or by exposure to materials that are poisonous to the kidney (nephrotoxic agents).

The internal structures of the kidney, particularly the tissues of the kidney tubule, become damaged or destroyed. ATN is one of the most common structural changes associated with the development of acute renal failure.

ATN, along with prerenal azotemia are the most common causes of renal failure in hospitalized patients. Risks for acute tubular necrosis include injury or trauma with resulting damage to the muscles, recent major surgery, blood transfusion reaction, septic shock or other forms of shock, and severe hypotension (low blood pressure) that lasts longer than 30 minutes.

Any condition that causes a reduction in the amount of blood being pumped by the heart may cause ATN. Liver disease and damage caused by diabetes (diabetic nephropathy) may make a person more susceptible to the condition.

ATN can be caused by:

• Exposure to nephrotoxic agents such as aminoglycoside antibiotics
• Antifungal agents such as amphotericin
• Dye used for radiographic (x-ray) studies

• Urine output, decreased or none
• Generalized swelling, fluid retention
• Nausea, vomiting
• Decreased consciousness
  • Drowsy, lethargic, hard to arouse
  • Delirium or confusion
  • Coma

Note: Other symptoms of acute renal failure may also be present.

Examination usually indicates acute renal failure. There may be signs of fluid overload, including abnormal sounds on listening to the heart and lungs with a stethoscope (auscultation).

• Urinalysis may show casts, renal tubular cells, and red blood cells.
• Urine sodium may be high.
• Fractional excretion of sodium and of urea may be relatively high.
• Urine specific gravity and osmolarity urine indicate dilute urine
• BUN and serum creatinine levels may increase.

A kidney biopsy may show acute tubular necrosis, but a biopsy is rarely performed.