Nephrology & Renal Medicine

Acute Tubular Necrosis (ATN), Ischemic/Nephrotoxic

ICD-10 Code

N17.0

Abrupt renal injury secondary to severe hypo-perfusion (ischemic) or direct cellular toxicity (e.g., contrast media, aminoglycosides, rhabdomyolysis pigments). Diagnosed by a rapid rise in creatinine, oliguria, urine sodium >40 mEq/L, FeNa >2%, and characteristic 'muddy brown' granular casts on urine microscopy.

Clinical Presentation & Protocol

Patient Usually Complains Of

Patient presents with acute onset of oliguria/anuria and rapid elevation of serum creatinine. History significant for [recent hypotension/sepsis/nephrotoxic exposure/rhabdomyolysis]. Denies obstructive symptoms or hematuria. No prior history of chronic kidney disease.

Clinical Examination Findings

Patient appears [ill/distressed/stable]. Vitals: BP [value], HR [value]. Skin: [dry mucous membranes/signs of dehydration/edema]. General assessment: Evidence of volume status [hypovolemic/euvolemic/hypervolemic]. No signs of systemic vasculitis or rash.

Treatment Protocol

1. Discontinue all nephrotoxic agents. 2. Optimize hemodynamic status (IV fluids/vasopressors as indicated). 3. Monitor strict I/Os and daily weights. 4. Manage electrolyte disturbances (hyperkalemia/metabolic acidosis). 5. Consider renal replacement therapy (RRT) if refractory indications develop.

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