Acute tubular necrosis
Management first targets rehydration and cessation of any causative agent. Prognosis is typically favorable due to the kidney's mechanism for replacement of tubular cells in approximately 1-3 weeks. In cases of severe kidney injury and complications (for example, extremely elevated serum potassium), dialysis may be necessary for supportive care.
N17.0 – Acute kidney failure with tubular necrosis
35455006 – Acute tubular necrosis
Differential Diagnosis & Pitfalls
- Prerenal azotemia – Look for an elevated BUN:creatinine ratio > 20, bland urine sediment, and resolution of acute kidney injury with fluid resuscitation.
- Acute interstitial nephritis – Look for onset of kidney injury 4-7 days after exposure to a new agent, particularly penicillin, cephalosporins, or long-term proton pump inhibitor use. Urinalysis may have WBCs and eosinophils.
- Obstructive uropathy – Renal ultrasound with bladder outlet obstruction or bilateral hydronephrosis. Note that hydronephrosis may not be evident in chronic obstruction.
- Nephritic syndrome (see glomerulonephritis) – Look for hypertension, microscopic and/or macroscopic hematuria, proteinuria 1-2 grams.
- Nephrotic syndrome – Look for proteinuria > 3 grams per day, edema, hyperlipidemia.
- Renal atheroembolic disease – Look for onset of acute kidney injury 2-4 weeks after cardiac catheterization, endovascular instrumentation, or cardioversion. Urine eosinophils may be present and serum complements may be low.
- Contrast-induced nephropathy – Look for iodinated contrast exposure 1-3 days prior to onset of acute kidney injury.
Drug Reaction Data