Acute Tubular Necrosis (ATN)
Although in clinical practice the term acute tubular necrosis (ATN) is often used synonymously with AKI, these terms should not be used interchangeably. Although ATN is the most common form of intrinsic AKI, particularly in critically ill patients, it represents only one of multiple causes of AKI - Prof. Charles RP George
HWN Suggests
The Rise and Fall of Acute Tubular Necrosis – An exercise in medical semiotics
Sudden cessation of renal function often has catastrophic clinical consequences. It must always have occurred since typical precipitants of it have existed for millennia. Even though physicians have observed patients and documented their findings over all those years a succinct description of the condition failed to impact broadly upon medical consciousness until the mid-20th century. It then took the mass destruction that accompanied ruthless bombing of civilians during World War II, together with astute conceptualisation by a few physicians, to create a composite awareness within the medical community that such a phenomenon does indeed often occur under appropriate circumstances, and to…
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Acute Tubular Necrosis: Recognizing and Documenting the Severity of Illness
It is estimated that approximately one-third of hospitalized patients with AKI have ATN. The etiology of ATN can be variable. Most common causes include hypotension, IV contrast, sepsis, nephrotoxic medications, surgery, and rhabdomyolysis.
Articles of Interest
Cast Morphology As A Clue to the Cause of Acute Tubular Injury
Without immunohistochemistry, myoglobin casts can be difficult to distinguish from hemoglobin casts that are typically seen in hemolytic anemias and glomerulonephritis. If the casts have a greenish hue (so called bile casts), the patient may have obstructive jaundice, fulminant hepatitis, or decompensated cirrhosis. Thus, examination of a kidney biopsy in a patient with persistent acute tubular injury can provide a window into systemic diseases afflicting the patient.
Resources
Toronto Notes
Pigmented (or Heme) Granular Casts
DoveMed
The prognosis of Acute Tubular Necrosis depends upon the severity at presentation and initiation of appropriate therapy. Nevertheless, unlike other acute kidney injuries or conditions, Acute Tubular Necrosis is usually reversible with appropriate treatment, if no major associated diseases are present.
MedBullets
A 44-year-old woman with no significant past medical history presents to the emergency room with toxic ingestion of ethylene glycol. She answers appropriately but requires frequent redirection. Physical exam reveals bilateral flank pain. Her serum creatinine, previously normal, is now increased at 3 mg/dL. Urinalysis with sediment analysis reveals granular casts and significant hematuria. Fomepizole is given.
WikiDoc
Acute tubular necrosis (ATN) defines a pathologic process rather than a clinical syndrome in which varying degrees of renal tubular injury occur. Clinically, ATN manifests as acute kidney injury although the terms have previously been used interchangeably. ATN is the most common cause of overt AKI.
