What are the sequences of disease progression in acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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ATN follows a well-defined three-part sequence of initiation, maintenance, and recovery (see Pathophysiology). The initiation phase is characterized by an acute decrease in glomerular filtration rate (GFR) to very low levels, with a corresponding sudden increase in serum creatinine and blood urea nitrogen (BUN) concentrations.

The maintenance phase is characterized by a sustained severe reduction in GFR that persists for a variable length of time, most commonly 1-2 weeks. Because the filtration rate is so low during the maintenance phase, the creatinine and BUN levels continue to rise.

The recovery phase, in which tubular function recovers, is characterized by an increase in urine volume (if oliguria was present during the maintenance phase) and by a gradual decrease in BUN and serum creatinine to their preinjury levels.

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