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Acute tubular necrosis



Renal system


Renal and ureteral disorders
Bladder and urethral disorders
Renal system pathology review

Acute tubular necrosis


0 / 17 complete


0 / 2 complete
High Yield Notes
10 pages

Acute tubular necrosis

17 flashcards

USMLE® Step 1 style questions USMLE

2 questions

A 45-year-old man is brought to the emergency department for evaluation following a motor vehicle accident. Trauma chest/abdomen/pelvis CT-imaging demonstrates multiple bilateral fractures, a right humeral shaft fracture, as well as splenic and liver lacerations with ongoing internal hemorrhage. The patient is resuscitated with type O negative blood and is taken to the operating room for repair of the aforementioned injuries. His condition remains stable postoperatively. Following surgery, his temperature is 38.0°C (100.4°F), pulse is 95/min, respirations are 20/min, and blood pressure is 115/70 mmHg. On his second day of hospitalization, his urine output decreases. Urine microscopy demonstrates granular casts and a calculated fractional excretion of sodium (FENa) of 3%. On the patient’s eighth day of hospitalization, a significant increase in urine output is noted. Serum creatinine charting is shown:


 Laboratory value  Result 
  On admission  Day 2  Day 8 
Creatinine  1.1 mg/dL  3.5 mg/dL  2.3 mg/dL 
   In the coming days, this patient is at highest risk of developing which of the following findings? 

External References

Acute tubular necrosis (ATN) is a type of acute kidney injury (AKI) that results in the sudden and rapid death of tubular cells in the kidneys. This can lead to a decrease in urine production and an increase in the levels of creatinine and urea in the blood.

ATN may be caused by sepsis leading to hypotension and renal hypoperfusion; ischemia due to renal hypoperfusion, like in hypovolemic shock; but it can also be due to exposure to toxins and nephrotoxic drugs which cause damage to the tubular cells. Such drugs include nephrotoxic antibiotics, contrast agents used during imaging studies, amphotericin B, and toxic heavy metals.