Acute Tubular Necrosis

Maimun Syukri,
 Anatomy of the Kidney

Pathology Dept , Renal

 NEPHRON
STRUCTURE

Pathology Dept , Renal

 Renal Corpuscle

Pathology Dept , Renal

 KIDNEY ANATOMY :
NEPHRONS

• Nephron is the functional unit of the

kidney.
• Each kidney contains about 1,000,000 to
1,300,000 nephrons.
• The nephron is composed of glomerulus
and renal tubules .
• The nephron performs its function by
ultra filtration at glomerulus and
secretion and reabsorption at renal
tubules.

Pathology Dept , Renal

 Concept

 With acute tubular necrosis part of the

body's kidneys are damaged when the
flow of blood and oxygen is
compromised. Acute tubular necrosis is
serious and can lead to acute kidney
failure. The good news is that in
otherwise healthy people it can be
reversible with early treatment
 Overview

What is acute tubular necrosis?

 Acute tubular necrosis is a condition that
causes the lack of oxygen and blood flow to
the kidneys, damaging them. Tube-shaped
structures in the kidneys, called tubules, filter
out waste products and fluid. These structures
are damaged in acute tubular necrosis.
 When this happens acute kidney failure may
occur, with electrolytes and fluids increasing
in the body, possibly past safe levels.
 SYMPTOMS AND CAUSES

What causes acute tubular necrosis?

 The most frequent causes of acute
tubular necrosis are a stroke or a heart
attack, conditions that reduce oxygen to
the kidneys.
 Chemicals can also damage the tubules.
These include X-ray contrast dye,
anesthesia drugs, antibiotics and other
toxic chemicals.
What are the risk factors for developing
acute tubular necrosis?

 Risk factors for acute tubular necrosis include

situations where blood flow is cut off or
reduced (as with blood clots), extended
periods of low blood pressure or shock.
 Blood loss from surgery and trauma can also
lead to acute tubular necrosis. Other risk
factors are muscle damage and liver disease.
What are the symptoms of acute tubular necrosis?

Symptoms of acute tubular necrosis include:

A small
Confusion. amount of
urine output.

Swelling and
Feeling
fluid
sluggish.
retention.

Trouble waking Nausea and

up/drowsiness. vomiting.
DIAGNOSIS AND TESTS
What tests are used to diagnose acute tubular
necrosis?

 Several tests can be used to diagnose acute renal failure. These

include blood waste products such as blood urea nitrogen (BUN),
creatinine and electrolyte levels such as plasma potassium. The
accumulation of these substances in the blood indicate that the
kidneys are not working properly.
 Acute tubular necrosis is usually diagnosed by a nephrologist
(kidney specialist). The diagnosis is mainly clinical but can be
guided by microscopic examination of your urine. A biopsy of the
kidney tissue can be done in certain cases, especially when the
diagnosis is uncertain.
MANAGEMENT AND TREATMENT

How is acute tubular necrosis treated?

 Treating the underlying cause is crucial in order to allow

the kidneys to recover. While the kidneys can often self-
heal, you may be required to follow some dietary
restrictions that include limiting fluid, sodium and
potassium intake. This prevents the build-up of those
substances while the kidneys are recovering. Diuretics
(drugs to increase urination) and potassium-controlling
medications may be prescribed.
 Dialysis may be needed until the kidneys improve
PREVENTION

Can acute tubular necrosis be prevented?

Maintaining blood flow and oxygen to the kidneys can reduce the chance of
developing acute tubular necrosis.

If a test with contrast dye is needed, drink a lot of water beforehand and
afterwards.

Make sure your blood has been cross-matched before you receive a transfusion.

Work with your doctor to control the diseases that can damage the kidneys,
such as high blood, pressure, diabetes, liver disease and heart disease.

Avoid over-the-counter anti-inflammatory medications such as naproxen

sodium and ibuprofen, especially if you have kidney disease.
OUTLOOK / PROGNOSIS
What is the outlook for someone with acute tubular
necrosis?

Acute tubular necrosis can last for a few

days or as long as several weeks. For
relatively healthy people, the condition
can be reversible. For those with other
health conditions, recovery may take
longer and may not be complete.