Present by

R.RAMAKRISHNAN.D.Pharm
Regist No:2701810002
Pathophysiology & Pharmacotherapeutics-III
B.Pharm(Practice)
Final Year 2019-2020
VM College of Pharmacy
Salem,Tamil nadu
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 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.

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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)

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 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

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 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.
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 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.

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 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.

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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.

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 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.

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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
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 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.
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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

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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.

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