Tubular Damage Crisis (ATN): Causes, Testing, and Additional Information

Tubular Kidney Injury (ATN): Causes, Diagnostic Tests, and Further Details

Acute Tubular Necrosis (ATN), a common cause of acute kidney injury, is primarily caused by ischemic injury and nephrotoxic injury [1][3].

Ischemic Causes

Severe hypovolemia from conditions such as diarrhea, vomiting, bleeding, or dehydration, can lead to ATN. Additionally, conditions that reduce kidney perfusion, like heart failure, cirrhosis, or burns, can also contribute to the development of ATN. Sepsis or anaphylaxis causing systemic vasodilation and hypotension, coagulopathies like disseminated intravascular coagulation (DIC), and other conditions that reduce renal blood flow can also result in ATN [1][3].

Nephrotoxic Causes

Certain medications, such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and chemotherapy agents, can damage the kidney tubule cells, leading to ATN. Radiographic contrast dyes used in imaging studies, heavy metals like lead or mercury, and crystal-induced nephropathies (e.g., uric acid, calcium phosphate crystals, light chain accumulation in multiple myeloma) are also potential causes of ATN [1][3].

Sepsis-Induced Mechanisms

Sepsis can induce low blood pressure and reduced blood flow to the kidneys, leading to ATN. The systemic inflammation caused by sepsis contributes to renal injury through mechanisms such as endotoxemia, inflammatory cytokine release, and oxidative stress [1].

Symptoms and Complications

People with ATN may experience low urine output, tiredness, swelling around the eyes and in the ankles and feet, nausea, confusion, shortness of breath, chest pain or pressure, seizures or coma in severe cases. Complications of ATN may include electrolyte disturbances such as hyperkalemia, hypocalcemia, and hyperphosphatemia, volume overload, and adverse effects from having high levels of urine in the blood such as increased tendency to blood, swelling of the sac-like tissue that surrounds the heart, and altered mental state [1].

Prevention and Treatment

Maintaining fluid volume in the body, maintaining moderate blood pressure, and avoiding nephrotoxic drugs such as NSAIDs and certain antibiotics may decrease the risk of ATN in high-risk populations. Diuretics may be used to manage urine volume but not to treat the condition. Other supportive treatments may include managing fluid intake, discontinuing nephrotoxic drugs, treating infection, avoiding nephrotoxic drugs where possible, nutritional support, and hemodialysis if diuretics do not manage fluid overload [1][3].

The outlook for people with ATN depends on the underlying condition, with a poorer outlook associated with factors such as low urine production, being male, poor nutrition, need for mechanical ventilation, seizures, stroke, and heart attack [1].

[1] Source: UpToDate, 2021 [3] Source: National Kidney Foundation, 2021 [5] Source: American Society of Nephrology, 2021

Health-related References

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Controlling conditions like heart failure, cirrhosis, and sepsis can help prevent the development of ATN, which often occurs due to reduced kidney perfusion or nephrotoxic agents.
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