Acute Tubular Necrosis

Acute tubular necrosis is damage and death (necrosis) of the epithelial cells of the renal tubules. It is the most common cause of acute kidney injury. Damage to the kidney cells occurs due to ischaemia or toxins. The epithelial cells have the ability to regenerate making acute tubular necrosis reversible. It usually takes 7-21 days to recover.


Ischaemia can occur secondary to hypoperfusion in:

  • Shock
  • Sepsis
  • Dehydration


Direct damage from toxins can occur due to:

  • Radiology contrast dye
  • Gentamycin
  • NSAIDs



Muddy brown casts” found on urinalysis is a pathognomonic finding specific to acute tubular necrosis. There can also be renal tubular epithelial cells in the urine.



Treatment is the same as with other causes of an acute kidney injury:

  • Supportive management
  • IV fluids
  • Stop nephrotoxic medications
  • Treat complications


Last updated April 2019