Overview

We all know that our kidneys play a vital role in both the urinary and endocrine system. They help flush the toxins out of the body. But what makes this possible? Here, the tubules present in the kidneys play a crucial role. These are small ducts that help filter the blood that is passed through them. Hence, the prime functionality of the kidneys, i.e., filtering toxins and waste fluids from the blood, is only possible due to these tubules. But what will happen if these tubules are damaged for any reason? It can be the onset of a disorder known as acute tubular necrosis (ATN). In such a case, the toxins will stay in our kidneys and can lead to various health complications, including death. The majority of times, this renal disorder becomes the reason for acute kidney injury (AKI), which is why both terms are often used interchangeably. As per the statistics published in Cancer Therapy Advisor, the mortality rate among ATN patients can be as high as 37% in hospitalised patients and 78% in patients in a critical stage and staying in the ICU.

Causes of Acute Tubular Necrosis

The prime causes of ATN are deficiency of oxygen supply and accumulation of toxins that lead to blockage and blood deficiency in the kidneys (a condition that is also known as renal ischemia). This condition may occur due to various reasons. These are:

- Existing health conditions: Many health problems, such as stroke or heart attack, can lead to a lack of oxygen in all the organs, including the kidney, and this renal disorder.
- Nephrotoxic medications: Some medications, including antibiotics, can negatively affect your kidneys and lead to ATN. These medications include sulfa drugs, cisplatin, tacrolimus, and amphotericin. Hence, you shouldn’t consume any medication without a medical prescription.
- Endogenous toxins: Excessive certain substances can damage our tubules, which may be produced in your body naturally. It includes haemoglobin (in the blood), plasma cells (in the case of multiple myeloma), etc.
- Exposure to harmful chemicals: It includes radiology dyes and other toxic chemicals.

Who is at a higher risk of developing acute tubular necrosis?

Any person who has experienced any of the following is at a higher risk of experiencing ATN:

- Negative reaction due to blood transfusion
- A direct injury or trauma that has damaged the muscles
- Major surgery or organ transplantation
- Liver problems or diabetes
- Low blood pressure for more than 30 minutes
- An infection that can lead to a sudden drop in blood pressure (also known as septic shock)

Symptoms of Acute Tubular Necrosis

- Significantly low or no urine output
- Experiencing swelling or fluid retention in the body
- Nausea and vomiting
- Experiencing dehydration or being unable to quench the thirst
- Feeling tired all the time
- Unable to wake up with energy and experiencing drowsiness
- Sudden confusion and an inability to stay focused

Treatment options for acute tubular necrosis

The treatment approach depends on the cause, so it becomes important to get a thorough diagnosis. The prime agenda of the treatment is to remove the toxins and work on the cause of the ATN kidney damage. It will help control further damage to tubules, and the kidneys can heal themselves. It can be as short as a few days or as long as six weeks. The treatment options include the following:

Dialysis

This treatment procedure can help remove all the toxins from the kidneys and promote their healing. Once the procedure is used to remove the toxins, kidneys go back to their normal functioning gradually.

Lifestyle and Dietary Changes

Our lifestyle and diet play a crucial role in our health. Sometimes, during the recovery phase, the patient may be advised to make certain changes in their diet and lifestyle that can help reduce the accumulation of fluids. It includes cutting sodium and potassium. Moreover, following an active lifestyle benefits our heart and blood pressure, which can help ATN patients reduce further complications.

Medication

Your doctor may prescribe some medicines(diuretics) that help increase urine levels and regulate potassium levels in the body to manage your health condition further.

Untreated ATN can lead to serious kidney problems, including kidney failure, so getting treatment as soon as possible is better.

When to Consult a Doctor

You can also get in touch with the expert Nephrology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during an injury, disorder or any other health concern.

Acute tubular necrosis is a renal disorder related to kidney damage from toxins that are building up due to the damage to tubules. Though various causes exist, they can be cured with the right treatment approach.

Frequently Asked Questions

Q. What are the most common causes of acute tubular necrosis? A. Any health condition, a regular dosage of some medicines, or exposure to chemicals that can affect the tubules and lead to a lack of oxygen in the kidney, further leading to ATN. The most common causes are:

- Sudden low blood pressure due to any injury, surgery, blood loss, serious burns, or serious infection
- Consuming medicines harsh on kidneys, like aminoglycoside antibiotics, amphotericin B, colistimethate, etc. These medications are often prescribed to treat infections.
- Health conditions such as stroke and heart attack.

Q. What is the treatment for acute tubular necrosis? A. The roadmap of the treatment depends on the severity of the case. The doctor may suggest medication, dietary changes, or dialysis, depending on your condition.

Q. What medications cause acute tubular necrosis? A. Yes, some medications can cause ATN when consumed for a long time. Hence, it is better to seek medical advice to understand your condition and know the next steps of the treatment.

Q. Can you recover from acute tubular necrosis? A. Yes, ATN is completely reversible and recoverable. You must improve your kidney health and religiously follow your doctor’s advice.

Q. How do you diagnose ATN? A. If you are experiencing any of the symptoms of ATN, then you may be advised to undergo the following diagnostic tests for further clarification:

- Urinalysis: To find abnormalities in your urine
- Blood urea nitrogen and creatinine urine test: To know the performance of your kidneys
- Biopsy: To understand the condition of your kidney on a cellular level
- CT scan of the kidney: To examine the kidney for abnormalities

Q. What are the 4 phases of ATN? A. Four different clinical phases of acute tubular necrosis are:

- Initiation - This is a phase where kidney damage from toxins starts at the cellular level. It usually lasts a few hours, and the glomerular filtration rate (GFR), a metric to check how well your kidneys can filter the blood, will decrease. The damaged tubules will obstruct blood filtration; hence, the kidneys will experience a backflow of unfiltered blood. Hence, the medical expert will be able to detect high levels of toxins in the blood.
- Extension - In this phase, the kidneys are damaged due to toxins, and the oxygen can’t reach the organs. As a result, the GFR will drop, leading to renal ischemia, and the organs can experience inflammation.
- Maintenance - It is a phase in which the cells start to repair and reestablish themselves, which helps in restoring the oxygen supply to the kidneys and clearing out toxins to some extent. But at the same time, the urine output is the lowest, and one can experience some symptoms of uremia.
- Recovery - With time, all the damaged tubules are either removed or replaced. The GFR will improve, and your kidneys can function normally.

Reference

- https://www.webmd.com/digestive-disorders/what-are-acute-tubular-necrosis-causes
- https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/acute-tubular-necrosis/
- https://www.healthline.com/health/acute-tubular-necrosis
- https://my.clevelandclinic.org/health/diseases/16426-acute-tubular-necrosis
- https://www.mountsinai.org/health-library/tests/hemoglobinuria-test
- https://www.msdmanuals.com/en-in/home/kidney-and-urinary-tract-disorders/kidney-filtering-disorders/acute-tubular-necrosis