Acute Kidney Tubular Necrosis

Written by Brindles Lee Macon and Winnie Yu | Published on August 16, 2012
Medically Reviewed by George Krucik, MD on August 16, 2012


Inside your kidneys are small tube-shaped structures that remove salt, excess fluids, and waste products from the blood. When these tubules are damaged or destroyed, you develop acute tubular necrosis (ATN). The damage may result in acute kidney failure.

What Causes Acute Tubular Necrosis?

The most common cause of ATN is a lack of oxygen. When blood can not reach the tissues and cells of the kidneys due to a blockage or restriction, the kidneys can be damaged or destroyed.

Harmful substances in the blood can also damage tubules. Toxins may change the way cells in the tubules function.

Certain chemicals and medications (such as antibiotics), anesthetics, and radiology dyes may cause ATN if your body reacts negatively to them.

Who Is at Risk for Acute Tubular Necrosis?

A number of factors may place you at risk for ATN. The risk factors depend on your overall health and any other medical issues such as:

Recent injury to your body, especially the kidneys.

The trauma may cause blood clots or another blockage to occur in the blood vessels servicing your kidneys.

A bad reaction to a blood transfusion.

Your body may reject or destroy the blood cells in transfused blood. This may lead to problems if your body cannot get sufficient blood supply to the kidneys.

Septic Shock

Septic shock may cause a drastic drop in your body’s blood pressure and slow blood circulation to the kidneys. This is very dangerous if you already have low blood pressure problems.

Recovering from a major surgical procedure

The surgery may cause complications with your blood supply or circulation.

Liver Disease or Damage

What are the Symptoms of Acute Tubular Necrosis?

The symptoms of ATN may vary depending on its severity. You may:

  • have problems waking up
  • feel drowsy even during the day
  • feel lethargic or physically drained
  • be excessively thirsty or experience dehydration
  • urinate very little or not at all
  • contain fluid or experience swelling in your body
  • have episodes of confusion
  • experience nausea or have the need to vomit

Diagnosing Acute Kidney Tubular Necrosis?

If your doctor suspects acute tubular necrosis, he or she may order specific diagnostic tests. These testing procedures include:

  • urinalysis to look for abnormal cells in your urine, the color of the urine, and signs of infection from bacteria and other organisms.
  • Blood Urea Nitrogen (BUN) to check for conditions such as kidney failure and disease.
  • biopsy to examine the kidney tissue.
  • blood tests to measure sodium and creatinine levels. Too much sodium may be a sign that your kidneys are not properly filtering the salt in your body. Creatinine levels show whether the kidneys are filtering wastes properly.
  • CT scan to take pictures of the inside of your kidneys.

Treating Acute Kidney Tubular Necrosis

Your doctor may prescribe medication to decrease the fluid and waste buildup in your kidneys. You may also be told to restrict your diet to reduce the amount of sodium and potassium in your body. You may also need to regulate the amount of water you drink to avoid excessive fluid retention. Too much fluid can lead to abnormal swelling (edema) in your arms, legs, and feet. As a last resort, you may temporarily need dialysis to help your kidneys filter out excess fluids and wastes.

What Is Expected in the Long Term?

You may see a decrease in urine output for up to six weeks. It may increase after that before returning to normal.


To avoid ATN, treat conditions that decrease oxygen and blood flow to the kidneys. Control existing conditions such as diabetes, heart disorders and liver disease. Drink plenty of water after using any contrast dyes. Ask your doctor to monitor your blood if you take medications that may be toxic to the kidneys.

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