What is the role of lab testing in the workup of acute tubular necrosis (ATN)?

Updated: Mar 15, 2021
  • Author: Sangeeta Mutnuri, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Suggested testing includes the following:

  • Complete blood cell count (CBC)
  • Blood urea nitrogen (BUN) and serum creatinine
  • Serum electrolytes
  • Urinalysis
  • Urine electrolytes
  • Renal ultrasound, if indicated
  • Novel biomarkers, if available 

The CBC may reveal anemia. Erythropoietin production is decreased in acute kidney injury (AKI), and dysfunctional platelets (from uremia) also make bleeding more likely.

The BUN and serum creatinine concentrations are increased in AKI. This increase in creatinine can be monitored at regular intervals and used for staging AKI, as described below.

In addition, hyponatremia, hyperkalemia, hypermagnesemia, hypocalcemia, and hyperphosphatemia may be present. Metabolic acidosis is also found. There can be improvement or worsening of acid-base status and electrolytes on inititiation of dialysis, and further calculations and dose adjustments will be required. [14]

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