Acute tubular necrosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
Acute tubular necrosis may usually develop through 3 phases, initiation, maintenance and recovery. Common complications of acute tubular necrosis include electrolyte imbalance(eg, hyperkalemia, hyperphosphatemia, metabolic acidosis), platelet dysfunction and altered consciousness or coma. Prognosis depends on the underlying etiology. when compared to ischemic acute tubular necrosis, nephrotoxic and mixed acute tubular necrosis have the good prognosis.
Natural History, Complications, and Prognosis
Natural History
- Acute tubular necrosis may usually develop through 3 phases, include[1]
- Phase of initiation
- Maintenance phase
- Phase of recovery
- Renal injury by ischemia, hypoxia, and nephrotoxins can occur in initiation phase. This phase is mostly preventable.
- After a renal injury, it may progress to renal failure depending upon the severity. once the acute renal failure is evident, there is marked decrease in glomerular filtration rate (GFR) resulting in oliguria.
- Oliguria resulting in accumulation of metabolic waste products and uremia that lead to altered mental status, cognitive impairment, and other complications.
- The duration of maintenance phase may vary from days to weeks.
- Maintenance phase is followed by a recovery phase which may usually last 3-6 weeks. Polyuria can occur due to decreased concentration capacity of kidneys in the maintenance phase.
- Eventually kidney recovery may take place resulting in normal glomerular filtration rate (GFR).
Complications
- Common complications of acute tubular necrosis include:[2]
- Hyperkalemia
- Hyponatraemia
- Metabolic acidosis
- Hypervolaemia / fluid retention
- Hyperphosphatemia
- Bleeding diathesis due to platelet dysfunction
- Oliguria
- Infection
- Shock
- Stupor or coma
Prognosis
- Prognosis of acute tubular necrosis depends on the underlying etiology responsible for the tubular damage.[3][4]
- Prognosis is generally good in nephrotoxic acute tubular necrosis with mortality rate approximately 10%.
- Prognosis of ischemic acute tubular necrosis depends on early diagnosis and treatment of underlying condition causing renal ischemia with mortality rate approximately 30%.
- Poor prognostic factors associated with increased mortality include:[5]
References
- ↑ 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.
- ↑ Santos WJ, Zanetta DM, Pires AC, Lobo SM, Lima EQ, Burdmann EA (2006). "Patients with ischaemic, mixed and nephrotoxic acute tubular necrosis in the intensive care unit--a homogeneous population?". Crit Care. 10 (2): R68. doi:10.1186/cc4904. PMC 1550879. PMID 16646986.
- ↑ Liaño F, Gallego A, Pascual J, García-Martín F, Teruel JL, Marcén R, Orofino L, Orte L, Rivera M, Gallego N (1993). "Prognosis of acute tubular necrosis: an extended prospectively contrasted study". Nephron. 63 (1): 21–31. doi:10.1159/000187139. PMID 8446248.
- ↑ Weisberg LS, Allgren RL, Genter FC, Kurnik BR (September 1997). "Cause of acute tubular necrosis affects its prognosis. The Auriculin Anaritide Acute Renal Failure Study Group". Arch. Intern. Med. 157 (16): 1833–8. PMID 9290542.
- ↑ Esson ML, Schrier RW (November 2002). "Diagnosis and treatment of acute tubular necrosis". Ann. Intern. Med. 137 (9): 744–52. PMID 12416948.