What Are Acute Tubular Necrosis Causes?

Medically Reviewed by Jabeen Begum, MD on November 22, 2021
4 min read

Acute tubular necrosis is a kidney disorder that’s caused by damage to tubule cells. These cells are found in the kidney and normally filter out your waste products and fluids.

The most common causes of this cell damage are heart attacks, strokes, and clots that cut off blood flow to your kidneys. Kidneys can also be directly damaged by poisons and other harmful substances.  

Acute tubular necrosis can be fatal.

Acute tubular necrosis is a kidney problem that could lead to kidney failure. When you have this condition, waste products, and fluids that are normally filtered out by your kidneys will remain in your body. 

This condition can be divided into four clinical phases, including: 

  • Initiation. This is the start of cell damage. At this point, your doctor can detect high levels of waste products in your blood. 
  • Extension. This is the amount of time that your kidneys remain poisoned or cut off from oxygen. The damage continues, and the organ becomes inflamed. 
  • Maintenance. Oxygen is restored—or the poison has cleared—and your cells start to repair themselves.
  • Recovery. Over time, all of the damaged cells are removed and replaced. Your kidneys begin to function normally. 

Acute tubular necrosis symptoms include: 

  • Little to no urine output
  • Fluid buildup and swelling
  • Nausea and vomiting
  • Confusion and mental grogginess 
  • Feelings of sleepiness and lethargy

Acute tubular necrosis can be diagnosed in a number of ways, including: 

  • Listening with a stethoscope. Your doctor may be able to hear abnormal sounds in your heart and lungs from the fluid that builds up. 
  • Urinalysis. Your doctor may use a urine test to check the levels of certain waste products and other chemicals. 
  • Analyzing blood urea nitrogen (BUN) levels. Your doctor may order a blood test to see if there are too many waste products in your blood, such as blood urea nitrogen. This chemical is normally filtered out of your blood by your kidneys. 
  • Biopsy. If your doctor cannot tell if your issue is acute tubular necrosis or another complication, they may need to take a biopsy — a sample of your kidney tissue e— in order to determine the actual cause of your symptoms. 

The exact treatment that your doctor recommends will depend on the cause of your acute tubular necrosis. 

If your acute tubular necrosis is caused by some form of poisoning, the most important treatment will be clearing the harmful substance out of your body. Then, you need to make sure that you know how the poison got into your body so it doesn’t happen again. 

Normally, your kidneys will be able to heal on their own. This means that your treatment will be focused on preventing the buildup of fluids and waste products in your body. 

Your treatment phase can last anywhere from a few days to over six weeks. It depends on how badly damaged your kidneys are. Treatment methods can include: 

  • Dialysis. In some cases, your doctor may decide that you need dialysis, a process that removes waste, salt, and fluids to prevent them from building up in the body while your kidneys are healing. They’ll decide this on a case-by-case basis. 
  • Dietary changes. Sometimes, you’ll also need to change your diet during your recovery. Helpful changes could include limiting how much fluid and sodium you eat and drink. This way, you don’t add to the fluid build-up that’s caused by the acute tubular necrosis. 
  • Medications. In some cases, your doctor will prescribe medications to take during your recovery. These include ones to help increase how often you urinate or to control potassium levels in your body. 

If this condition is left untreated, your kidneys could fail. This could mean that you need to make life-long changes to manage the symptoms from the tissue damage.    

Most people will be able to fully recover their kidney functions, but there can be complications if you have other health problems. There’s always a chance that your kidneys will never fully recover after your doctor has finished treating your acute tubular necrosis.

Part of your recovery will be managing any other health conditions that you have. Diabetes, liver disease, and heart disease, for example, can all damage your kidneys and lead to problems with your recovery. 

People don’t always recover from acute tubular necrosis. Risk factors that can lead to death include: 

  • Being male
  • Having poor nutrition
  • Needing mechanical ventilation
  • Having an increased risk of stroke
  • Having an increased risk of seizure 

Always talk to your doctor if you stop urinating or experience many of the symptoms listed above.