Acute tubular necrosis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]


Acute tubular necrosis is commonly caused by renal ischemia resulting from conditions such as volume depletion, hypotension, septic shock, heart failure, cirrhosis, and DIC. It is also caused by exposure to various nephrotoxic medications including aminoglycosides, amphotericin B, ACE inhibitors, NSAIDs, antiviral drugs, and also caused by exposure to radio contrast substances.


Life-threatening Causes

  • Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
  • Life-threatening causes of acute tubular necrosis may include marked volume depletion, septic shock, DIC, and hypotension.

Common Causes

Acute tubular necrosis is commonly caused by renal hypoperfusion resulting in ischemia, nephrotoxic medications and nephrotoxic substance exposure.

Causes by Organ System

Cardiovascular Heart failure
Chemical/Poisoning Ethylene glycol poisoning
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect

Aminoglycosides, amphotericin B, contrast media, cisplatin, ifosfamide, foscarnet, pentamidine, cidofovir, tenofovir, acyclovir, bisphosphonates, Cephalosporin, naproxen, tacrolimus, mannitol, NSAIDs, ACE inhibitors, cytotoxic drugs, cyclosporine, sucrose.

Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Vomitings, diarrhea
Genetic No underlying causes
Hematologic Myoglobinuria, hemoglobinuria, multiple myeloma
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic Rhabdomyolysis
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Malignancy
Ophthalmologic No underlying causes
Overdose/Toxicity Vitamin C excessive intake
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Acute crystal nephropathy
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma Fractures, Crush injuries
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order:

List the causes of acute tubular necrosis in alphabetical order.

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  1. Basile DP, Anderson MD, Sutton TA (April 2012). "Pathophysiology of acute kidney injury". Compr Physiol. 2 (2): 1303–53. doi:10.1002/cphy.c110041. PMC 3919808. PMID 23798302.
  2. Ibrahim AE, Sarhane KA, Fagan SP, Goverman J (March 2013). "Renal dysfunction in burns: a review". Ann Burns Fire Disasters. 26 (1): 16–25. PMC 3741002. PMID 23966894.
  3. Ramoutar V, Landa C, James LR (August 2014). "Acute tubular necrosis (ATN) presenting with an unusually prolonged period of marked polyuria heralded by an abrupt oliguric phase". BMJ Case Rep. 2014. doi:10.1136/bcr-2013-201030. PMC 4154042. PMID 25150229.
  4. Ratcliffe PJ, Moonen CT, Holloway PA, Ledingham JG, Radda GK (September 1986). "Acute renal failure in hemorrhagic hypotension: cellular energetics and renal function". Kidney Int. 30 (3): 355–60. PMID 3784280.
  5. Alobaidi R, Basu RK, Goldstein SL, Bagshaw SM (January 2015). "Sepsis-associated acute kidney injury". Semin. Nephrol. 35 (1): 2–11. doi:10.1016/j.semnephrol.2015.01.002. PMC 4507081. PMID 25795495.
  6. Dhanapriya J, Gopalakrishnan N, Arun V, Dineshkumar T, Sakthirajan R, Balasubramaniyan T, Haris M (2016). "Acute kidney injury and disseminated intravascular coagulation due to mercuric chloride poisoning". Indian J Nephrol. 26 (3): 206–8. doi:10.4103/0971-4065.164230. PMC 4862267. PMID 27194836.
  7. Fukunaga S, Ishida C, Nakaoka A, Ito T (May 2015). "A case of acute kidney injury and disseminated intravascular coagulation associated with influenza B viral infection". CEN Case Rep. 4 (1): 95–100. doi:10.1007/s13730-014-0147-9. PMC 5413716. PMID 28509280.
  8. Goldfarb M, Abassi Z, Rosen S, Shina A, Brezis M, Heyman SN (August 2001). "Compensated heart failure predisposes to outer medullary tubular injury: studies in rats". Kidney Int. 60 (2): 607–13. doi:10.1046/j.1523-1755.2001.060002607.x. PMID 11473643.
  9. Moreau R, Lebrec D (2007). "Diagnosis and treatment of acute renal failure in patients with cirrhosis". Best Pract Res Clin Gastroenterol. 21 (1): 111–23. doi:10.1016/j.bpg.2006.10.004. PMID 17223500.
  10. Al Shohaib S, Raweily E (2000). "Acute tubular necrosis due to captopril". Am. J. Nephrol. 20 (2): 149–52. doi:10.1159/000013573. PMID 10773617.
  11. Ejaz P, Bhojani K, Joshi VR (August 2004). "NSAIDs and kidney". J Assoc Physicians India. 52: 632–40. PMID 15847359.
  12. Mingeot-Leclercq MP, Tulkens PM (May 1999). "Aminoglycosides: nephrotoxicity". Antimicrob. Agents Chemother. 43 (5): 1003–12. PMC 89104. PMID 10223907.
  13. Fanos V, Cataldi L (December 2000). "Amphotericin B-induced nephrotoxicity: a review". J Chemother. 12 (6): 463–70. doi:10.1179/joc.2000.12.6.463. PMID 11154026.
  14. Lang EK, Foreman J, Schlegel JU, Leslie C, List A, McCormick P (January 1981). "The incidence of contrast medium induced acute tubular necrosis following arteriography". Radiology. 138 (1): 203–6. doi:10.1148/radiology.138.1.7455084. PMID 7455084.
  15. Wadd NJ, Tiplady C, Roberts JT (1997). "Cisplatin and acute tubular necrosis". Clin Oncol (R Coll Radiol). 9 (4): 267–8. PMID 9315405.
  16. Berns JS, Haghighat A, Staddon A, Cohen RM, Schmidt R, Fisher S, Rudnick MR, Tomaszewski JE (August 1995). "Severe, irreversible renal failure after ifosfamide treatment. A clinicopathologic report of two patients". Cancer. 76 (3): 497–500. PMID 8625132.
  17. Deray G, Martinez F, Katlama C, Levaltier B, Beaufils H, Danis M, Rozenheim M, Baumelou A, Dohin E, Gentilini M (1989). "Foscarnet nephrotoxicity: mechanism, incidence and prevention". Am. J. Nephrol. 9 (4): 316–21. doi:10.1159/000167987. PMID 2554731.
  18. Prabhavalkar S, Masengu A, O'Rourke D, Shields J, Courtney A (2013). "Nebulized pentamidine-induced acute renal allograft dysfunction". Case Rep Transplant. 2013: 907593. doi:10.1155/2013/907593. PMC 3562641. PMID 23401840.
  19. Ortiz A, Justo P, Sanz A, Melero R, Caramelo C, Guerrero MF, Strutz F, Müller G, Barat A, Egido J (2005). "Tubular cell apoptosis and cidofovir-induced acute renal failure". Antivir. Ther. (Lond.). 10 (1): 185–90. PMID 15751777.
  20. Herlitz LC, Mohan S, Stokes MB, Radhakrishnan J, D'Agati VD, Markowitz GS (December 2010). "Tenofovir nephrotoxicity: acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities". Kidney Int. 78 (11): 1171–7. doi:10.1038/ki.2010.318. PMID 20811330.
  21. Izzedine H, Launay-Vacher V, Deray G (May 2005). "Antiviral drug-induced nephrotoxicity". Am. J. Kidney Dis. 45 (5): 804–17. PMID 15861345.
  22. Perazella MA, Markowitz GS (December 2008). "Bisphosphonate nephrotoxicity". Kidney Int. 74 (11): 1385–93. doi:10.1038/ki.2008.356. PMID 18685574.
  23. Longstreth KL, Robbins SD, Smavatkul C, Doe NS (June 2004). "Cephalexin-induced acute tubular necrosis". Pharmacotherapy. 24 (6): 808–11. doi:10.1592/phco.24.8.808.36069. PMID 15222673.
  24. Kovacevic L, Bernstein J, Valentini RP, Imam A, Gupta N, Mattoo TK (August 2003). "Renal papillary necrosis induced by naproxen". Pediatr. Nephrol. 18 (8): 826–9. doi:10.1007/s00467-003-1167-4. PMID 12774222.
  25. Ardalan MR, Nasri H, Ghabili K, Mohajel Shoja M (December 2008). "Acute tubular necrosis after renal allograft segmental infarction: the nephrotoxicity of necrotic material". Exp Clin Transplant. 6 (4): 312–4. PMID 19338495.
  26. Dorman HR, Sondheimer JH, Cadnapaphornchai P (May 1990). "Mannitol-induced acute renal failure". Medicine (Baltimore). 69 (3): 153–9. PMID 2111870.
  27. Fakhouri F (May 2007). "[Intravenous immunoglobulins and acute renal failure: mechanism and prevention]". Rev Med Interne (in French). 28 Spec No. 1: 4–6. PMID 17768831.
  28. Dussol B, Reynaud-Gaubert M, Saingra Y, Daniel L, Berland Y (October 2000). "Acute tubular necrosis induced by high level of cyclosporine A in a lung transplant". Transplantation. 70 (8): 1234–6. PMID 11063346.
  29. Kadiri S, Ogunlesi A, Osinfade K, Akinkugbe OO (October 1992). "The causes and course of acute tubular necrosis in Nigerians". Afr J Med Med Sci. 21 (1): 91–6. PMID 1288251.
  30. Dimopoulos MA, Kastritis E, Rosinol L, Bladé J, Ludwig H (August 2008). "Pathogenesis and treatment of renal failure in multiple myeloma". Leukemia. 22 (8): 1485–93. doi:10.1038/leu.2008.131. PMID 18528426.
  31. Darmon M, Ciroldi M, Thiery G, Schlemmer B, Azoulay E (2006). "Clinical review: specific aspects of acute renal failure in cancer patients". Crit Care. 10 (2): 211. doi:10.1186/cc4907. PMC 1550893. PMID 16677413.
  32. Choudhry WM, Nori US, Nadasdy T, Satoskar AA (May 2016). "An unexpected cause of acute kidney injury in a patient with ANCA associated vasculitis". Clin. Nephrol. 85 (5): 289–95. doi:10.5414/CN108760. PMID 26932179.
  33. Seo JW, Lee JH, Son IS, Kim YJ, Kim DY, Hwang Y, Chung HA, Choi HS, Lim SD (December 2012). "Acute oxalate nephropathy caused by ethylene glycol poisoning". Kidney Res Clin Pract. 31 (4): 249–52. doi:10.1016/j.krcp.2012.09.007. PMC 4716116. PMID 26889430.
  34. Cossey LN, Rahim F, Larsen CP (June 2013). "Oxalate nephropathy and intravenous vitamin C". Am. J. Kidney Dis. 61 (6): 1032–5. doi:10.1053/j.ajkd.2013.01.025. PMID 23548555.

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