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</div><div><span>Acute tubular necrosis</span></div></div>
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</a><h1 class="with-also" itemprop="name">Acute tubular necrosis</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Acute tubular necrosis (ATN) is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to <a test="test" href="./000501.htm">acute kidney failure</a>. The tubules are tiny ducts in the kidneys that help filter the blood when it passes through the kidneys.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>ATN is often caused by a lack of blood flow and oxygen to the kidney tissues (ischemia of the kidneys). It may also occur if the kidney cells are damaged by a poison or harmful substance.</p><p>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 that can lead to acute kidney failure.</p><p>ATN is a common cause of kidney failure in people who are in the hospital. Risks for ATN include:</p><ul><li><a test="test" href="./001303.htm">Blood transfusion reaction</a></li><li>Injury or trauma that damages the muscles</li><li>Low blood pressure (hypotension) that lasts longer than 30 minutes</li><li>Recent major surgery</li><li><a test="test" href="./000668.htm">Septic shock</a> (serious condition that occurs when a body-wide infection leads to dangerously low blood pressure)</li></ul><p>Liver disease and kidney damage caused by diabetes (<a test="test" href="./000494.htm">diabetic nephropathy</a>) may make a person more prone to develop ATN.</p><p>ATN can also be caused by medicines that are toxic to the kidneys. These medicines include aminoglycoside antibiotics and the antifungal drug amphotericin.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Symptoms may include any of the following:</p><ul><li><a test="test" href="./003202.htm">Decreased consciousness</a>, coma, <a test="test" href="./000740.htm">delirium</a> or <a test="test" href="./003205.htm">confusion</a>, drowsiness, and lethargy</li><li><a test="test" href="./003147.htm">Decreased urine output</a> or no urine output</li><li>General swelling, fluid retention</li><li>Nausea, vomiting</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Your health care provider will perform a physical exam. Your provider may hear abnormal sounds when listening to the heart and lungs with a stethoscope. This is due to too much fluid in the body.</p><p>Tests that may be done include:</p><ul><li><a test="test" href="./003474.htm">Blood urea nitrogen (BUN)</a> and serum creatinine</li><li><a test="test" href="./003602.htm">Fractional excretion of sodium</a></li><li><a test="test" href="./003907.htm">Kidney biopsy</a></li><li><a test="test" href="./003579.htm">Urinalysis</a></li><li><a test="test" href="./003599.htm">Urine sodium</a></li><li><a test="test" href="./003587.htm">Urine specific gravity</a> and <a test="test" href="./003609.htm">urine osmolarity</a></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>In most people, ATN is reversible. The goal of treatment is to prevent life-threatening complications of acute kidney failure</p><p>Treatment focuses on preventing the buildup of fluids and wastes, while allowing the kidneys to heal.</p><p>Treatment may include any of the following:</p><ul><li>Identifying and treating the underlying cause of the problem</li><li>Restricting fluid intake</li><li>Taking medicines to help control the potassium level in the blood</li><li>Medicines taken by mouth or through an IV to help remove fluid from the body </li></ul><p>Temporary <a test="test" href="../patientinstructions/000707.htm">dialysis</a> can remove excess waste and fluids. This can help improve your symptoms so that you feel better. It may also make kidney failure easier to control. Dialysis may not be necessary for all people, but is often lifesaving, especially if <a test="test" href="./003484.htm">potassium</a> is dangerously high.</p><p>Dialysis may be needed in the following cases:</p><ul><li>Decreased mental status</li><li>Fluid overload</li><li>Increased potassium level</li><li><a test="test" href="./000182.htm">Pericarditis</a> (inflammation of the sac-like covering around the heart)</li><li>Removal of toxins that are dangerous to the kidneys</li><li>Total lack of urine production</li><li>Uncontrolled buildup of nitrogen waste products </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>ATN can last for a few days to 6 weeks or more. This may be followed by 1 or 2 days of making an unusually large amount of urine as the kidneys recover. Kidney function often returns to normal, but there may be other serious problems and complications.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>Contact your provider if your urine output decreases or stops, or if you develop other symptoms of ATN.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Promptly treating conditions that can lead to decreased blood flow as well as decreased oxygen to the kidneys can reduce the risk for ATN.</p><p>Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.</p><p>Diabetes, liver disorders, and heart problems need to be managed well to reduce the risk for ATN.</p><p>If you know you're taking medicine that can injure your kidneys, ask your provider about having your blood level of the medicine checked regularly.</p><p>Drink a lot of fluids after having any contrast dyes to allow them to be removed from the body and reduce the risk for kidney damage.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Necrosis - renal tubular; ATN; Necrosis - acute tubular</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/1101t.jpg" alt="Kidney anatomy" title="Kidney anatomy" class="side-img"/><a href="../imagepages/1101.htm">Kidney anatomy</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/1704t.jpg" alt="Kidney - blood and urine flow" title="Kidney - blood and urine flow" class="side-img"/><a href="../imagepages/1704.htm">Kidney - blood and urine flow</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Gunning S, Koyner JL. Acute tubular injury and acute tubular necrosis. In: Gilbert S, ed. <em>National Kidney Foundation Primer on Kidney Diseases</em>. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 32.</p><p>Weisbord SD, Palevsky PM. Prevention and management of acute kidney injury. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. <em>Brenner and Rector's The Kidney</em>. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 29.</p></div></div></section>
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<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 8/28/2023</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. </p>
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