genitourinary disorders
Acute Tubular Necrosis (ATN)
Etiology of Acute Tubular Necrosis
Common causesof acute tubular necrosis include the following: Renal hypoperfusion, most often caused by hypotension or sepsis (ischemic ATN; most common, especially in patients in an intensive care unit) Nephrotoxins Major surgery (often due to multiple factors) Other causes of ATN include Third-degree burns covering>15% of body surface area The heme pigments myoglobin and hemoglobin (caused by either Rhabdomyolysis or massive Other endogenous toxins, resulting from disorders such as Tumor Lysis and Cytokine Release Syndromes or Poisons, such as ethylene glycol Herbal and folk remedies, such as ingestion of fish gallbladder in Southeast Asia Common nephrotoxins include the following: Aminoglycosides Amphotericin B Cisplatinand other chemotherapy agents 100 mL—see Contrast Nephropathy ) Nonsteroidal anti-inflammatory drugs (NSAIDs; especially when concurrent with poor renal perfusion or other nephrotoxic agents) Colistimethate (colistin) Calcineurin inhibitors (eg,cyclosporine,tacrolimus, used systemically) (particularly with supratherapeutic dosing [ Etiology references ]) Massive volume loss, particularly in patients with septic or hemorrhagic shock, pancreatitis, or major surgery, increases the risk of ischemic ATN; patients with serious comorbidities are at highest risk. Major surgery and advanced hepatobiliary disease ( Etiology references ) increase the risk of aminoglycoside toxicity. Certain combinations of medications (eg, aminoglycosides with Toxic exposures cause patchy, segmental, tubular luminal occlusion with casts and cellular debris or segmental tubular necrosis. Acute tubular necrosis is more likely to develop in patients with the following: Preexisting Chronic Kidney Disease None Diabetes Mellitus (DM) None Preexisting hypovolemia or poor renal perfusion Older age 1.Stokes MB:Vancomycinin the kidney—A novel cast nephropathy.J Am Soc Nephrol28(6):1669-1670, 2017. doi: 10.1681/ASN.2017010091 2.Aniort J, Poyet A, Kemeny J-L, et al: Bile cast nephropathy caused by obstructive cholestasis.Am J Kidney Dis69(1):143-146, 2017. doi: 10.1053/j.ajkd.2016.08.023 