Acute Tubular Necrosis Clinical Presentation

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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The patient’s history is very important in the diagnosis of acute tubular necrosis (ATN), as it can establish the risk factors for the development of ATN. A careful historical timeline of events leading to acute kidney injury (AKI) can frequently identify the underlying cause. 

The history commonly reveals recent surgery, hypotension, sepsis, muscle necrosis, or volume depletion, as well as exposure to nephrotoxic agents. Several of those may be present simultaneously, which increases the risk and severity of ATN. 

In addition, pre-existing medical conditions or medication use (eg, diabetes mellitus, multiple myeloma, nonsteroidal anti-inflammatory drugs) may contribute to the worsening of renal function. Hence, a thorough medical and medication history can also be key to the diagnosis.




Physical Examination

Physical examination findings are often unremarkable and acute kidney injury (AKI) is incidentally detected on routine laboratory studies (ie, elevated blood urea nitrogen [BUN] and creatinine levels).

Findings may suggest hypovolemia (eg, low jugular venous pressure, loss of skin turgor, orthostatic hypotension, dry mucous membranes, tachycardia) as a cause. Abdominal distension may raise the concern of intra-abdominal hypertension and compartment syndrome as a potential cause of ATN. Muscle tenderness could potentially be due to rhabdomyolysis, which can lead to ATN.