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Acute tubular necrosis

Necrosis - renal tubular; ATN; Necrosis - acute tubular

Acute tubular necrosis (ATN) is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure. The tubules are tiny ducts in the kidneys that help filter the blood when it passes through the kidneys.


Kidney anatomy
Kidney - blood and urine flow


ATN is often caused by a lack of blood flow and oxygen to the kidney tissues (ischemia of the kidneys). It may also occur if the kidney cells are damaged by a poison or harmful substance.


ATN is a common cause of kidney failure in people who are in the hospital. Risks for ATN include:

Liver disease and kidney damage caused by diabetes (diabetic nephropathy) may make a person more prone to develop ATN.

ATN can also be caused by medicines that are toxic to the kidneys. These medicines include aminoglycoside antibiotics and the antifungal drug amphotericin.


Symptoms may include any of the following:

Exams and Tests

The health care provider will perform a physical exam. The provider may hear abnormal sounds when listening to the heart and lungs with a stethoscope. This is due to too much fluid in the body.

Tests that may be done include:



Treatment focuses on preventing the buildup of fluids and wastes, while allowing the kidneys to heal.

Treatment may include any of the following:

Temporary dialysis can remove excess waste and fluids. This can help improve your symptoms so that you feel better. It may also make kidney failure easier to control. Dialysis may not be necessary for all people, but is often lifesaving, especially if potassium is dangerously high.

Dialysis may be needed in the following cases:

Outlook (Prognosis)

ATN can last for a few days to 6 weeks or more. This may be followed by 1 or 2 days of making an unusually large amount of urine as the kidneys recover. Kidney function often returns to normal, but there may be other serious problems and complications.

When to Contact a Medical Professional

Call your provider if your urine output decreases or stops, or if you develop other symptoms of ATN.


Promptly treating conditions that can lead to decreased blood flow as well as decreased oxygen to the kidneys can reduce the risk for ATN.

Blood transfusions are crossmatched to reduce the risk of incompatibility reactions.

Diabetes, liver disorders, and heart problems need to be managed well to reduce the risk for ATN.

If you know you're taking medicine that can injure your kidneys, ask your provider about having your blood level of the medicine checked regularly.

Drink a lot of fluids after having any contrast dyes to allow them to be removed from the body and reduce the risk for kidney damage.

Related Information

Acute kidney failure
Hemolytic transfusion reaction
Septic shock
Diabetes and kidney disease
Chronic kidney disease
End-stage kidney disease
High blood pressure - adults


Turner JM, Coca SG. Acute tubular injury and acute tubular necrosis. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation's Primer on Kidney Diseases. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 32.

Weisbord SD, Palevsky PM. Prevention and management of acute kidney injury. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 29.


Review Date: 7/16/2019  


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