Acute Tubular Necrosis (ATN)

ATN is a type of intra-renal acute kidney injury that occurs with ischemia of tubule cells. ATN may be caused by nephrotoxins such as myoglobin from rhabdomyolysis. ATN follows three phases:

1. Oliguria due to obstruction of nephrons with necrotic cells. Symptoms include:

   • Uremia and azotemia.
   • Hypervolemia and Hypertension.
   • Hyperkalemia.

2. Polyuria / diuresis due to immature cells replacing necrotic tissue. Recovery begins! Symptoms include:

   • Azotemia.
   • Hypokalemia.

3. Convalescence as normal kidney function returns.

Important details about each phase.

• Hemolytic uremic syndrome of varying severity can occur in the oliguric phase.
• Recovery begins in the polyuric phase.
• If convalescence does occur, injury will progress into end-stage renal disease.
• Usually a permanent degree of renal insufficiency persists.