Which endogenous nephrotoxins cause acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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In myoglobinuria, rhabdomyolysis is the most common cause of heme pigment–associated acute kidney injury (AKI) and can result from traumatic or nontraumatic injuries. Most cases of rhabdomyolysis are nontraumatic, such as those related to alcohol abuse or drug-induced muscle toxicity (eg, statins alone or in combination with fibrates).

In hemoglobinuria, AKI is a rare complication of hemolysis and hemoglobinuria, and most often is associated with transfusion reactions (in contrast to myoglobin, hemoglobin has no apparent direct tubular toxicity, and AKI in this setting is probably related to hypotension and decreased renal perfusion). [8]

Acute crystal-induced nephropathy occurs when crystals are generated endogenously due to high cellular turnover (ie, uric acid, calcium phosphate), as observed in certain malignancies or the treatment of malignancies. However, this condition is also associated with ingestion of certain toxic substances (eg, ethylene glycol) or nontoxic substances (eg, vitamin C). Choudhry et al reported a case of AKI caused by ingestion of excessive quantities of calcium-containing antacids. [9]

In multiple myeloma, renal impairment results from the accumulation and precipitation of light chains, which form casts in the distal tubules that cause renal obstruction. In addition, myeloma light chains have a direct toxic effect on proximal renal tubules. [10]

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