Acute Tubular Necrosis (ATN)

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Acute Tubular Necrosis is a frequently overlooked cause of acute kidney failure.

There are three major causes of ATN.

  • Renal Ischemia
    • Hypotension/Hypovolemia
    • Shock
  • Sepsis
  • Nephrotoxins
    • Contrast nephropathy
    • Medications (antibiotics, antifungals, immunosuppressive agents, etc.)
    • Rhabdomyolysis

Clinical data supporting a diagnosis of Acute Tubular Necrosis includes:

  • Clinical history such as an episode of hypotension or exposure to a nephrotoxic agent
  • AKI that lasts for > 3 days after fluid resuscitation
  • Urinalysis with significant proteinuria, muddy brown casts, or epithelial cell casts
  • Fractional excretion of sodium is > 2%

Documentation Examples:

  • “Acute renal failure secondary to probable ATN”

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