Presentation by JoAnn Czech RN/CDS

St. Cloud Hospital

 Acute tubular necrosis is kidney injury
characterized by acute tubular cell injury and
dysfunction.
 Common causes are hypotension causing renal
hypoperfusion and nephrotoxic drugs. The
condition is asymptomatic unless it causes renal
failure
 The diagnosis is suspected when azotemia
develops after a hypotensive event, severe sepsis,
or drug exposure and is distinguished from
prerenal azotemia by laboratory testing and
response to volume expansion.
 Hypotension (ischemic ATN, common)
 Nephrotoxins (common)
 Sepsis (common)
 Major surgery
 Third-degree burns covering > 15% of BSA
 Disorders resulting in other endogenous toxins,
such as tumor lysis or multiple myeloma
(uncommon)
 Massive volume loss, particularly in patients
with septic or hemorrhagic shock or
pancreatitis or in patients who have had
serious surgery, increases the risk of ischemic
ATN.
 ATN is more likely to develop in patients with
the following:
 Baseline creatinine clearance < 47 mL/min
 Diabetes mellitus
 Preexisting hypovolemia or poor renal
perfusion
 ATN is usually asymptomatic but may cause symptoms or
signs of acute renal failure, typically oliguria.
 Differentiation from prerenal azotemia, based mainly on
laboratory findings and, in the case of blood or fluid loss,
response to volume expansion.
 ATN is suspected when serum creatinine rises ≥ 0.5
mg/dL/day above baseline after an apparent trigger. It may
occur days after exposure to some nephrotoxins.
 ATN must be differentiated from prerenal azotemia because
treatment differs. In prerenal azotemia, renal perfusion is
decreased enough to elevate serum BUN out of proportion to
creatinine, but not enough to cause ischemic damage to tubular
cells.
 Prerenal azotemia can be caused by direct
intravascular fluid loss (eg, from hemorrhage,
GI tract or urinary losses) or by a relative
decrease in effective circulating volume without
loss of total body fluid (eg, in heart failure or
portal hypertension with ascites).
 If fluid loss is the cause, volume expansion
using IV normal saline solution normalizes
serum creatinine level.
 If ATN is the cause, IV saline typically causes
no rapid change in serum creatinine.
 Renal (kidney) cortical necrosis is death of the
tissue in the outer part of kidney (cortex) that
results from blockage of the small arteries that
supply blood to the cortex and that causes acute
kidney failure.
 Usually the cause is a major, catastrophic disorder
that decreases blood pressure.
 Symptoms may include dark urine, decreased
urine volume, fever, and pain in the side of the
body.
 Sometimes an imaging test or tissue analysis
(biopsy) is done to confirm the diagnosis.
 Renal cortical necrosis can occur at any age.
About 10% of the cases occur in infants and
children..
 The next most common cause is a bacterial
infection of the bloodstream (sepsis).
 In children, renal cortical necrosis may follow
severe infection, severe dehydration, shock, or
the hemolytic-uremic syndrome.
 In adults, sepsis causes one third of all cases of
renal cortical necrosis.
 Other causes in adults include rejection of a
transplanted kidney, burns, inflammation of
the pancreas, injury, use of certain drugs, and
poisoning from certain chemicals.
 The diagnosis is often confirmed with an
imaging test such as computed tomography
(CT) angiography.
 Kidney biopsy can give doctors the most
accurate diagnostic information, but a biopsy
involves removing kidney tissue and may be
unnecessary if the diagnosis is evident.
 Renal papillary necrosis is a disorder of the
kidneys in which all or part of renal papillae
die.
 The renal papillae is the area where the
openings of the collecting ducts enter the
kidney.
 Necrosis (tissue death) of the renal papillae
may make the kidney unable to concentrate
the urine
 Conditions causing this condition:
 Diabetic Nephropathy
 Kidney infection
 Kidney transplant rejection
 Urinary tract obstruction
 Sickle cell anemia is a common cause of renal
papillary necrosis.
 Symptoms may include:
 Back pain or flank pain
 Bloody urine
 Cloudy urine
 Dark, rust-colored, or brown urine
 Tissue in the urine
 Chills
 Incontinence
 Increased urinary frequency or urgency
 An examination may reveal tenderness when
touching the body over the affected kidney.
 There may be a history of chronic or recurrent
urinary tract infections. There may be signs of
obstructive uropathy or renal failure.
 A urinalysis may show dead tissue in the urine.
 An IVP may show obstruction or tissue .
 There is no specific treatment for renal
papillary necrosis. Treatment depends on the
underlying cause. If the underlying cause can
be controlled, it may go away on its own.