Acute tubular necrosis

Alternative names:

ATN; necrosis - acute tubular; necrosis - renal tubular; vasomotor nephropathy

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

Note: Other symptoms of acute renal failure may also be present.

Signs and tests:

Examination usually indicates acute renal failure. There may be signs of fluid overload, including abnormal sounds on listening to the heart and lungs with a stethoscope (auscultation).

• Urinalysis may show casts, renal tubular cells, red blood cells.
• Urine sodium may be high.
• Fractional excretion of sodium and of urea may be relatively high.
• Urine specific gravity and osmolarity urine indicate dilute urine.
• The ratio of urine to plasma (blood) levels of creatinine and urea may be reduced.
• BUN and serum creatinine levels may increase.

A kidney biopsy may show acute tubular necrosis, but a biopsy is rarely performed.

This disease may also alter the results of the following tests:

• RBC; urine
• potassium; urine
• osmolality
• creatinine clearance
• creatinine - urine
• abdominal MRI