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by McCoy K


Acute tubular necrosis (ATN) is injury to the tiny tube-shaped cells in the kidneys. ATN can lead to more serious kidney problems.

Anatomy of the Kidney
Copyright © Nucleus Medical Media, Inc.


ATN has many causes:

  • Lack of oxygen to the kidneys because of:
    • Blood clots
    • Problems from surgery
    • Blood loss
    • Excessive fluid loss— dehydration
    • Health conditions
  • Toxins such as medicines, dyes used in image testing, or anesthesia

Risk Factors

Your chances for ATN go up as you get older. Risk is also higher with:

  • Having problems that lower blood flow:
    • Kidney disease
    • Blood pressure that’s too high or low
    • Heart, liver, or lung diseases
    • Diabetes
    • Cancer
  • Taking certain medicines
  • Surgery
  • Working with or being around toxins


ATN may cause:

  • Lower or higher amounts of urine than normal
  • Swelling
  • Weight gain
  • Nausea and vomiting
  • Lack of hunger
  • Confusion


The doctor will ask about your symptoms and health history. You may also have:

  • A physical exam
  • Blood tests to look for certain proteins and to count blood cells
  • Urine tests to look for certain proteins and other markers
  • Ultrasound
  • Scintigraphy


Care depends on what is causing problems. For example, if medicine you take is harming your kidneys, your doctor will make changes. Other care may involve:

  • Support to manage fluids, blood flow, oxygen, or nutrition
  • Medicines to treat infections
  • Dialysis —a machine works for your kidneys by filtering your blood


To lower your chances of ATN, don’t take medicines you know cause kidney problems. Your doctor will find other medicines to help you.


National Institute of Diabetes and Digestive and Kidney Diseases  https//www.niddk.nih.gov 

National Kidney Foundation  https://www.kidney.org 


Health Canada  https://www.canada.ca 

The Kidney Foundation of Canada  https://www.kidney.ca 


Acute tubular necrosis. EBSCO DynaMed website. Available at:  http://www.ebscohost.com/dynamed  . Updated April 26, 2018. Accessed June 1, 2018.

Acute tubular necrosis (ATN). Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/genitourinary-disorders/tubulointerstitial-diseases/acute-tubular-necrosis-atn. Updated July 2017. Accessed June 1, 2018.

Choudhury D, Ahmed Z. Drug-associated renal dysfunction and injury. Nat Clin Pract Nephrol. 2006;2(2):80-91

Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med. 2002;137(9):744-52.

Gill N, Nally JV Jr, Fatica RA. Renal failure secondary to acute tubular necrosis: Epidemiology, diagnosis, and management. Chest. 2005;128(4):2847-2863.

Musso CG, Liakopoulos V, Ioannidis I, Eleftheriadis T, Stefanidis I. Acute renal failure in the elderly: Particular characteristics. Int Urol Nephrol. 2006;38(3-4):787-793.

Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast reductions in renal function by acetylcysteine. N Engl J Med. 2000;343(3):1448-1457.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
  • Review Date: 05/2018
  • Update Date: 06/01/2018