Phases, evaluation and treatment of acute renal tubular necrosis

Najlaa Matouq Baddour; Mishari Mohammad Beragdar; Khaled Hussein Bagais; Khalid Abdullah Alattas; Muaid Hashem Morad; Muataz Abdulmoghni Aljunaid; Naif Mishkhas Alazwari; Abdulilah Ateeq Alsolami; Mohammed Omar Aljiffry; Mohammed Omar Yahya; Hanadi Halil Alenazi

doi:10.18203/2394-6040.ijcmph20232394

Authors

Najlaa Matouq Baddour Department of Nephrology, Al Noor Hospital, Mecca, Saudi Arabia
Mishari Mohammad Beragdar College of Medicine, Baha University, Al Baha, Saudi Arabia
Khaled Hussein Bagais Department of Internal Medicine, Jeddah Eye Hospital, Jeddah, Saudi Arabia
Khalid Abdullah Alattas Security Forces Hospital, Arar, Saudi Arabia
Muaid Hashem Morad College of Medicine, Baha University, Al Baha, Saudi Arabia
Muataz Abdulmoghni Aljunaid Department of Internal Medicine, Dr. Samir Abbas Hospital, Jeddah, Saudi Arabia
Naif Mishkhas Alazwari Department of Internal Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
Abdulilah Ateeq Alsolami College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Mohammed Omar Aljiffry Department of Nephrology, King Fahad General Hospital, Jeddah, Saudi Arabia
Mohammed Omar Yahya Department of Internal Medicine, King Abdulaziz Hospital, Jeddah, Saudi Arabia
Hanadi Halil Alenazi Public Health, Hail General Hospital, Hail, Saudi Arabia

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20232394

Keywords:

ATN, Kidney injury, Renal function, Management, Evaluation

Abstract

Acute renal tubular necrosis (ATN) is a severe kidney injury characterized by the death of renal tubular cells, resulting in impaired kidney function. This condition is associated with high morbidity and mortality rates, necessitating effective management strategies. This article provides a comprehensive overview of the evaluation and management of ATN. The evaluation process involves a combination of clinical assessment, laboratory investigations, and imaging modalities to confirm the diagnosis, identify the underlying cause, and assess the severity of the renal injury. The management of ATN encompasses addressing the underlying cause, providing supportive care, and preventing complications. This includes pharmacological interventions, fluid management, electrolyte balance, and renal replacement therapy in severe cases. Patient education, close monitoring, and preventive measures play critical roles in optimizing outcomes. Understanding the phases of ATN, including initiation, maintenance, and recovery, is essential to tailoring management strategies. Further research is needed to advance diagnostic modalities, therapeutic interventions, and preventive strategies for ATN, leading to improved patient outcomes.

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References

Hanif MO, Bali A, Ramphul K. Acute renal tubular necrosis. In: StatPearls. StatPearls Publishing. 2022.

Santos WJ, Zanetta DM, Pires AC, Lobo S, Lima EQ, Burdmann EA. Patients with ischaemic, mixed and nephrotoxic acute tubular necrosis in the intensive care unit–a homogeneous population? Critical Care. 2006;10(2):1-9.

Rosen S, Stillman IE. Acute tubular necrosis is a syndrome of physiologic and pathologic dissociation. J Am Society Nephrol. 2008;19(5):871-5.

Mercado MG, Smith DK, Guard EL. Acute kidney injury: diagnosis and management. Am Family Physician. 2019;100(11):687-94.

Nolin TD, Himmelfarb J. Mechanisms of drug-induced nephrotoxicity. Adverse Drug React. 2010:111-30.

Linkermann A, De Zen F, Weinberg J, Kunzendorf U, Krautwald S. Programmed necrosis in acute kidney injury. Nephrology Dialysis Transplantation. 2012;27(9):3412-9.

Rahman M, Shad F, Smith MC. Acute kidney injury: a guide to diagnosis and management. American family physician. 2012;86(7):631-9.

Kamal A. Estimation of blood urea (BUN) and serum creatinine level in patients of renal disorder. Indian J Fundam Appl Life Sci. 2014;4(4):199-202.

Kanbay M, Kasapoglu B, Perazella MA. Acute tubular necrosis and pre-renal acute kidney injury: utility of urine microscopy in their evaluation-a systematic review. Int Urol Nephrol. 2010;42:425-33.

Prowle JR, Kirwan CJ, Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nature Rev Nephrol. 2014;10(1):37-47.

Lameire N, Vanholder R. Pathophysiologic features and prevention of human and experimental acute tubular necrosis. J Am Society Nephrol. 2001;12(1):S20-32.

Kundert F, Platen L, Iwakura T, Zhao Z, Marschner JA, Anders H-J. Immune mechanisms in the different phases of acute tubular necrosis. Kidney Res Clin Pract. 2018;37(3):185.

Turner JM, Coca SG. Acute tubular injury and acute tubular necrosis. In: National Kidney Foundation Primer on Kidney Diseases. Elsevier; 2018:311-9.

Heyman SN, Lieberthal W, Rogiers P, Bonventre JV. Animal models of acute tubular necrosis. Curr Opinion Critical Care. 2002;8(6):526-34.

Bhandare PA, Gadekar GJ, Bandawane DD. Drug Induced Nephrotoxicity: A Mechanistic Approach. 2020.

Dunnill M. A review of the pathology and pathogenesis of acute renal failure due to acute tubular necrosis. J Clin Pathol. 1974;27(1):2.

Doi K, Katagiri D, Negishi K, et al. Mild elevation of urinary biomarkers in prerenal acute kidney injury. Kidney Int. 2012;82(10):1114-20.

Okusa MD. Etiology and diagnosis of prerenal disease and acute tubular necrosis in acute kidney injury in adults. 2019.

Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Int Med. 2002;137(9):744-52.

West BL, Picken MM, Leehey DJ. Albuminuria in acute tubular necrosis. Nephrol Dialysis Transplantation. 2006;21(10):2953-6.

Barozzi L, Valentino M, Santoro A, Mancini E, Pavlica P. Renal ultrasonography in critically ill patients. Critical Care Med. 2007;35(5):S198-205.

Tranquart F, Lebranchu Y, Haillot O, Pourcelot D, Grezard O, Pourcelot L. The use of perioperative Doppler ultrasound as a screening test for acute tubular necrosis. Transplant Int. 1993;6(1):14-7.

Kalantarinia K. Novel imaging techniques in acute kidney injury. Curr Drug Targ. 2009;10(12):1184-9.

Albright Jr RC. Acute renal failure: a practical update. Paper presented at: Mayo Clinic Proceedings. 2001.

Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders H-J. Acute kidney injury. Nature reviews Disease primers. 2021;7(1):52.

Heung M, Wolfgram DF, Kommareddi M, Hu Y, Song PX, Ojo AO. Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury. Nephrol Dialysis Transplantation. 2012;27(3):956-61.

Song J, Wu W, He Y, Lin S, Zhu D, Zhong M. Value of the combination of renal resistance index and central venous pressure in the early prediction of sepsis-induced acute kidney injury. Journal of critical care. 2018;45:204-8.

Batlle D, Arruda J. Hyperkalemic forms of renal tubular acidosis: clinical and pathophysiological aspects. Advances in Chronic Kidney Dis. 2018;25(4):321-33.

Rodriguez-Soriano J. The renal regulation of acid-base balance and the disturbances noted in renal tubular acidosis. Pediatr Clin N Am. 1971;18(2):529-45.

Gunnerson K. Emergency department management of acute kidney injury, electrolyte abnormalities, and renal replacement therapy in the critically ill. Emergency Med Clin. 2019;37(3):459-71.

Murray P, Hall J. Renal replacement therapy for acute renal failure. Am J Respiratory Crit Care Med. 2000;162(3):777-81.

Lisowska-Myjak B. Serum and urinary biomarkers of acute kidney injury. Blood Purification. 2010;29(4):357-65.

Sancho-Martínez SM, Prieto L, Blanco-Gozalo V. Acute tubular necrosis: An old term in search for a new meaning within the evolving concept of acute kidney injury. New Horizons Translational Med. 2015;2(4-5):110-17.

Harty J. Prevention and management of acute kidney injury. Ulster Med J. 2014;83(3):149.