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Acute Tubular Necrosis

Overview

A kidney disorder involving damage to the renal tubule cells, resulting in acute kidney failure .


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Causes

Acute tubular necrosis (ATN) is caused by ischemia of the kidneys (lack of oxygen to the tissues) or by exposure to materialsthat are poisonous to the kidney (nephrotoxic agents). The internal structures of the kidney, particularly the tissues of thekidney tubule, become damaged or destroyed. ATN is one of the most common structural changes associated with thedevelopment of acute renal failure .Risks for acute tubular necrosis include injury or trauma with resulting damage tothe muscles, recent major surgery, blood transfusion reaction, septic shock or other forms of shock, and severe hypotension (lowblood pressure) that lasts longer than 30 minutes. Any condition that causes a reduction in the amount of blood being pumpedby the heart may cause ATN. Liver disease and damage caused by diabetes mellitus (diabetic nephropathy) may predispose aperson to the condition. ATN can be caused by exposure to nephrotoxic agents such as aminoglycoside antibiotics, antifungalagents such as amphotericin, medications to prevent rejection of transplanted organs such as cyclosporine, dye used forradiographic studies, and other substances.


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Signs & Symptoms

 urine output, decreased or none- urination, excessive volume- urination, excessive at night- generalized swelling, fluid retention- nausea, vomiting- consciousness, decreased- drowsy, lethargic, hard to arouse- delirium or confusion- coma- seizures- easy bruising or bleeding- vomiting blood- stools, bloody- decrease in sensation, especially the hands or feet- chills shaking- abnormal urine color- blood in the urine- joint pain- flank pain. Other symptoms of acute renal failure may also be present.

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Prevention

Prompt treatment of conditions that can result in decreased blood flow and/or decreased oxygenation of the kidneys may reducethe risk of acute tubular necrosis.Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.Disorders such as diabetes, liver disorders, or cardiac disorders must be controlled as much as possible to reduce the risk ofATN.Exposure to medications that can be toxic to the kidney should be carefully monitored. Serum levels of the medication may bechecked regularly. Adequate hydration after radiocontrast dyes may allow their excretion and reduce the risk of kidney damage .


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Treatments
Dialysis Modern Medicine

Treatment

Treatment aims on prevention of  the excess build-up of fluids and wastes, and to prevent kidneys from furhter damage.

Treatment includes

  • Treating underlying cause of the problem
  • To restrict fluid intake, substances like protein sodium to minimize its buildup in body
  • Medication to control potassium in blood
  • Diuretics

Dialysis

Dialysis is done to  remove excess waste and fluids. This makes patient feel better, and prevent  the kidney failure. Dialysis may not be necessary for all people, but is often lifesaving, especially if is dangerously high.

Dialysis may be needed in the following cases:

  • Decreased mental status
  • Fluid overload
  • Increased potassium levels
  • Pericarditis
  • Total lack of urine production
  • Uncontrolled buildup of nitrogen waste products
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