ACUTE TUBULAR NECROSIS

SUMMARY

1. ATN is caused by ischemia (abrupt decrease in renal perfusion) or a nephrotoxin.

2. Nephrotoxic ATN has endogenous and exogenous causes:

• Endogenous - free myoglobin (rhabdomyolysis), free hemoglobin (intravascular hemolysis)

• Exogenous - contrast-related, drugs (aminoglycosides, amphotericin B, foscamet), osmotic nephropathy-IVIG with sucrose/mannitol/dextran, especially in patients with underlying chronic kidney disease, acute phosphate nephropathy, use of bowel purgatives containing sodium phosphate

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].