What is the pathophysiology of endotoxemia (sepsis)-related acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Sepsis is a recognized cause of ATN. However, the hypothesis that ATN develops in these cases when sepsis-related hypotension leads to a reduction in renal blood flow has been challenged by several animal and human studies. Those studies have indicated that in fact, renal blood flow may increase in that setting, due to a mechanism leading to efferent arteriolar vasodilatation. [6]

Other suspected contributors to ATN in sepsis include the following:

  • Intra-renal vasoconstriction and redistribution of renal blood flow to the cortex
  • Activation of vasoactive intrarenal hormones (endothelin, renin-angiotensin- aldosterone)
  • Nitric oxide synthase induction and release of several cytokines

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