# Acute Tubular Necrosis
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**Acute tubular necrosis** or **ATN** is a condition where the epithelial cells of the [[nephron#anatomy|renal tubule]] are damaged so badly that they die and are sloughed off. It is the most common cause of intrarenal [[acute kidney injury]].
## Cause
Acute tubular necrosis can be caused by a variety of reasons:
- low perfusion
- a lack of blood flow to the kidneys (which can be caused by things such as dehydration, shock, obstruction, etc.) causes [[tissue perfusion|ischemia]] in the parenchyma of the kidney.
- nephrotoxic medications
- NSAIDS, vancomycin, lithium, contrast (big one)
- infections
- especially [[sepsis]]
- autoimmune disorders
- [[systemic lupus erythematosus]]
## Signs & Symptoms
The signs and symptoms of acute tubular necrosis are largely those that have to do with the decreased kidney function.
- **muddy brown casts** in the urine are *pathognomonic* for (or are only found in) ATN
- these are the ischemic, sloughed off cells of the renal tubules
- decreased urine output
- edema (fluid buildup)
- buildup of toxins/wastes
- fatigue
- confusion
- nausea/vomiting
- seizures are a rare but severe complication of ATN
## Complications
Acute tubular necrosis is the main intrarenal cause of [[acute kidney injury|AKI]].
## Diagnostic Tests
Urinalysis, especially looking for those muddy brown casts.
## Treatment
Fortunately acute tubular necrosis is reversible if the underlying cause is treated. It takes about 7-14 days to heal up.
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