What is the pathophysiology of normotensive ischemic acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

This is a condition that develops in patients without an overt severe hypotensive episode. These patients have low-normal blood pressure but still have severe ATN. The most common reason for this condition is renal susceptibility to the lower blood pressure because of impairment of autoregulatory function of the kidney. Normally, the afferent arteriole dilates (via prostaglandins) and efferent arteriole constricts (via angiotensin-II)  to maintain the glomerular capillary pressure. Factors that impair this autoregulatory mechanisms include the following [5] :

  • Advanced age
  • Atherosclerosis, hypertension, and chronic kidney disease
  • Malignant hypertension
  • Medications impairing the autoregulatory mechanism (eg, nonsteroidal anti-inflammatory drugs [NSAIDs])
  • Afferent glomerular vasoconstriction  (eg, from sepsis, hypercalcemia, hepatorenal syndrome, cyclosporine/tacrolimus)
  • Drugs blocking efferent arteriolar vasoconstriction - Angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs)

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