Acute tubular necrosis  Urine osmolality is less than 400 mOsm/kg.

Overview  Urine sodium level is 40 to 60 mEq/L.

 Injury to the nephron's tubular segment resulting from ischemic  Blood urea nitrogen and serum creatinine levels are elevated.
or  Anemia is present.
nephrotoxic injury and causing renal failure and uremic syndrome
 Platelet adherence is defective.
 Also known as intrinsic renal azotemia  Metabolic acidosis is present.
Pathophysiology
 Hyperkalemia is found.
 In ischemic injury, circulatory collapse, severe hypotension,
trauma, Diagnostic procedures
hemorrhage, dehydration, cardiogenic or septic shock, surgery,  Electrocardiography may show arrhythmias and, with
anesthetics, and reactions to transfusions may cause disruption of hyperkalemia, awidening QRS complex, disappearing P waves, and
blood tall, peaked T waves.
flow to the kidneys.
 Renal ultrasound, computed tomography scanning, or magnetic
 Nephrotoxic injury may follow ingestion of certain chemical resonanceimaging measures kidney size and excludes obstruction.
agents, such
as contrast medium or antibiotics, or result from a hypersensitive
reaction
of the kidneys.
Causes
 Diseased tubular epithelium
 Ischemic or toxic injury to glomerular epithelial cells or vascular
endothelium
 Obstructed urine flow
Incidence
 Acute tubular necrosis accounts for about 75% of acute renal
failure cases.
 This disorder is the most common cause of acute renal failure in
critically
ill patients.
Complications
 Heart failure
 Uremic pericarditis
 Pulmonary edema
 Uremic lung
 Anemia
 Anorexia, intractable vomiting
 Poor wound healing due to debilitation
Warning
Fever and chills may signal the onset of an infection, the
leading cause
of death in acute tubular necrosis.
Assessment
 Diagnosis usually delayed until the condition has progressed to
anadvanced stage
History
 Ischemic or nephrotoxic injury
 Urine output less than 400 ml/24 hours
 Fever and chills
Physical findings
 Evidence of bleeding abnormalities, such as petechiae and
ecchymosis
 Dry, pruritic skin
 Dry mucous membranes
 Uremic breath
 Cardiac arrhythmia, if hyperkalemic
 Muscle weakness
Diagnostic test results
Laboratory
 Urinary sediment contains red blood cells (RBCs) and casts.
 Urine specific gravity is 1.010.