Acute Tubular Necrosis

Condition 101

What is the definition of Acute Tubular Necrosis?

Acute tubular necrosis (ATN) is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure. The tubules are tiny ducts in the kidneys that help filter the blood when it passes through the kidneys.

What are the alternative names for Acute Tubular Necrosis?

Necrosis - renal tubular; ATN; Necrosis - acute tubular

What are the causes for Acute Tubular Necrosis?

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.

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.

ATN is a common cause of kidney failure in people who are in the hospital. Risks for ATN include:

  • Blood transfusion reaction
  • Injury or trauma that damages the muscles
  • Low blood pressure (hypotension) that lasts longer than 30 minutes
  • Recent major surgery
  • Septic shock (serious condition that occurs when a body-wide infection leads to dangerously low blood pressure)

Liver disease and kidney damage caused by diabetes (diabetic nephropathy) may make a person more prone to develop ATN.

ATN can also be caused by medicines that are toxic to the kidneys. These medicines include aminoglycoside antibiotics and the antifungal drug amphotericin.

What are the symptoms for Acute Tubular Necrosis?

Symptoms may include any of the following:

  • Decreased consciousness, coma, delirium or confusion, drowsiness, and lethargy
  • Decreased urine output or no urine output
  • General swelling, fluid retention
  • Nausea, vomiting

What are the current treatments for Acute Tubular Necrosis?

In most people, ATN is reversible. The goal of treatment is to prevent life-threatening complications of acute kidney failure

Treatment focuses on preventing the buildup of fluids and wastes, while allowing the kidneys to heal.

Treatment may include any of the following:

  • Identifying and treating the underlying cause of the problem
  • Restricting fluid intake
  • Taking medicines to help control potassium level in the blood
  • Medicines taken by mouth or through an IV to help remove fluid from the body

Temporary dialysis 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 potassium is dangerously high.

Dialysis may be needed in the following cases:

  • Decreased mental status
  • Fluid overload
  • Increased potassium level
  • Pericarditis (inflammation of the sac-like covering around the heart)
  • Removal of toxins that are dangerous to the kidneys
  • Total lack of urine production
  • Uncontrolled buildup of nitrogen waste products

What is the outlook (prognosis) for Acute Tubular Necrosis?

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.

When should I contact a medical professional for Acute Tubular Necrosis?

Call your provider if your urine output decreases or stops, or if you develop other symptoms of ATN.

How do I prevent Acute Tubular Necrosis?

Promptly treating conditions that can lead to decreased blood flow as well as decreased oxygen to the kidneys can reduce the risk for ATN.

Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.

Diabetes, liver disorders, and heart problems need to be managed well to reduce the risk for ATN.

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.

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.


Turner JM, Coca SG. Acute tubular injury and acute tubular necrosis. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation's Primer on Kidney Diseases. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 32.

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. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 29.

Latest Research

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  • Journal: Transplantation proceedings
  • Treatment Used: Multiple-Artery Left Kidney Nephrectomy (MALKN) or Right Kidney Nephrectomy (RKN)
  • Number of Patients: 0
  • Published —
This study analyzed the outcomes after multiple-artery left kidney nephrectomy (MALKN) and right kidney nephrectomy (RKN).
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  • Journal: Minerva chirurgica
  • Treatment Used: Endovascular Repair vs. Open Repair
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This review of the literature compared the outcomes of open surgical repair and endovascular interventions for ruptured abdominal aortic aneurysm (RAAA).
Latest Advance
  • Condition: Acute Kidney Injury (AKI) in Critically Ill Patients
  • Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
  • Treatment Used: Tidal Peritoneal Dialysis (TPD) vs. Continuous Renal Replacement Therapy (CVVHDF)
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This study compared the outcome of acute kidney injury (AKI) in intensive care unit (ICU) patients randomized to treatment with tidal peritoneal dialysis (TPD) or continuous venovenous hemodiafiltration (CVVHDF).

Clinical Trials

Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 70
  • Start Date: July 15, 2019
FURosemide Stress Test to Predict Need of Renal Replacement THERapy in Ischemic Acute Tubular Necrosis in ICU
Clinical Trial
  • Status: Recruiting
  • Participants: 90
  • Start Date: January 1, 2019
Optimal Clinical Predictors to Acute Kidney Injury in Cirrhotic Patients Experienced Acute Gastrointestinal Hemorrhage
Clinical Trial
  • Status: Active, not recruiting
  • Study Type: Procedure
  • Participants: 100
  • Start Date: August 13, 2018
Renal Biopsy Findings In Patients With Unexplained Elevated Serum Creatinine In Assiut University Hospital
Clinical Trial
  • Status: Recruiting
  • Study Type: Other
  • Participants: 200
  • Start Date: September 8, 2016
Impact of the Composition of the Packed Red Blood Cell Supernatant on Renal Dysfunction and Post-transfusion Immunomodulation