What causes ischemic acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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ATN is generally caused by an acute event, either ischemic or toxic.

Causes of ischemic acute tubular necrosis

Ischemic ATN may be considered part of the spectrum of prerenal azotemia, and indeed, ischemic ATN and prerenal azotemia have the same causes and risk factors. Specifically, these include the following:

  • Hypovolemic states: Hemorrhage, volume depletion from gastrointestinal (GI) or renal losses, burns, fluid sequestration
  • Low cardiac output states: Heart failure and other diseases of myocardium, valvulopathy, arrhythmia, pericardial diseases, tamponade
  • Systemic vasodilation: Sepsis, anaphylaxis
  • Surgical procedures in which renal blood flow is compromised (eg, those that involve clamping of the renal artery, such as coronary artery bypass grafting [CABG], aortic dissection repair, renal cell carcinoma resection)

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