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Renal and patient outcomes after acute tubular necrosis

Orfeas Liangos, MD, FASN
Bertrand L Jaber, MD, MS, FASN
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD


Most patients with acute tubular necrosis (ATN) spontaneously recover renal function. Recovery is usually heralded by an increase in urine output and a gradual return of the blood urea nitrogen (BUN) and serum creatinine concentration to or very near the previous baseline level [1-3].

Renal and patient outcomes following an episode of ATN are reviewed here. The terms "ATN" and "acute kidney injury (AKI)" are sometimes used interchangeably in the literature. Studies that discuss prolonged or severe AKI, particularly in the critical care setting, are predominantly focused on ATN. However, it is important to note that the term AKI encompasses more than just ischemic or postischemic intrinsic kidney injury, and, while ATN is its most common form, it is not the only form of AKI. Since epidemiologic studies cannot distinguish between the various forms of AKI, we use the term "AKI" in these cases.

The diagnosis, pathogenesis, and possible treatment of this disorder and issues related to the definition of AKI are discussed separately. (See "Diagnostic approach to the patient with subacute kidney injury in an outpatient setting" and "Etiology and diagnosis of prerenal disease and acute tubular necrosis in acute kidney injury (acute renal failure)" and "Pathogenesis and etiology of postischemic (ischemic) acute tubular necrosis" and "Possible prevention and therapy of postischemic (ischemic) acute tubular necrosis" and "Definition of acute kidney injury (acute renal failure)".)


The incidence and prevalence of ATN are not well known, which is due in part to differences in definition and characteristics of assessed patients. In addition, as noted above, epidemiologic studies of acute kidney injury (AKI) do not reliably identify the etiology.

In a meta-analysis that included 143 studies and >3.5 million patients, among hospitalized patients, the global incidence of AKI, as defined according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, was estimated to be 22 percent [4]. The KDIGO definition of AKI is discussed elsewhere (see "Definition of acute kidney injury (acute renal failure)", section on 'KDIGO modifications to RIFLE and AKIN'). However, a more recent cross-sectional study of 97 intensive care units (ICUs) from 33 countries and based on data from 1802 patients during their first week of ICU admission showed a much higher AKI burden. Fifty-seven and three-tenths percent of enrolled patients fulfilled the KDIGO criteria for AKI (95% CI 55.0-59.6) [5].


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Literature review current through: Sep 2016. | This topic last updated: Aug 1, 2016.
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