What is included in long-term monitoring of acute tubular necrosis (ATN)?

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

AKI in hospital inpatients has long-term implications after discharge. A meta-analysis of 13 cohort studies showed that patients with AKI had higher risk for developing chronic kidney disease (CKD) (hazard ratio [HR] 8.8, 95% confidence index [CI] 3.1-25.5), end-stage renal disease (HR 3.1, 95%CI 1.9-5.0) and mortality (HR 2.0, 95% CI 1.3 - 3.1). [36] AKI was also independently associated with risk of cardiovascular disease and congestive heart failure. Patients with AKI whose kidney function does not return to 25% of baseline have higher risk of mortality and renal outcomes. [37]

KDIGO guidelines recommend a 3-month follow-up after an AKI to determine whether the patient has experienced renal recovery or new-onset or progressive CKD. [25] Longer followup may benefit all patients, but may be especially valuable in patients with higher risk of poor outcomes. Higher-risk features are as follows [38] :

  • AKI requiring dialysis
  • Pre-existing CKD
  • Failure of kidney function to return to baseline
  • History of diabetes, heart failure, or cancer

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