Acute tubular necrosis is the one of the most dangerous disease, it causes kidney failure and uremic syndrome. But don’t you worry about it because acute kidney failure is reversible or it can be recovered. Acute tubular necrosis treatment could help decrease the mortality of this disease. Please read the acute tubular necrosis treatments below for better understanding of how to treat it.
Yet, it would be better if we read about what is acute tubular necrosis in detail.
Acute Tubular Necrosis Definition
Acute tubular necrosis (ATN) is the cause of acute kidney failure generally in critical patient, and this disease is about 75 % cases in acute kidney failure. Microscopically, ATN is signed by tubular epithelium cells destruction. This condition leads to kidney function decrease or acute renal failure. ATN defects nephron tubular segment so that make kidney failure and uremic syndrome. Mortality is about 70% depend on complication caused. Patient with non-oliguria ATN has better prognosis.
Acute Tubular Necrosis Causes
- Tubular epithelium disturbances
- Ischemic injury in glomerular epithelial cells
- Ischemic injury in vascular endothelial
- Urine flow obstruction
Sign and Symptoms
- Abnormal bleeding like petechial and ecchymosis
- Small urine output
- Mucosal membrane and skin dry
- Mouth odor is like uremia
- Uremic syndrome with oliguria or anuria, and confusion that can develop to uremic coma
Diagnosis examination is the most important part in acute tubular necrosis treatment guides. Right diagnosis defines right treatment of this disease. Doctors usually test the patient with these diagnosis examinations.
- Urinalysis shows urinating sediment with red blood cell and cylinder structure. Specific urine gravity is low about 1,010, low osmolality about 400 mOsm/kg, and natrium level is high about 40-60 mEq/L.
- Blood study shows urea nitrogen level increase, and also increase in creatinine serum, anemia, thrombocyte adhesion, metabolic acidosis, and hyperkalemia.
- Electrocardiogram can be a diagnosis examination for arrhythmia caused by electrolyte imbalance, if there is hyperkalemia; the ECG will show QRS complex widening, missing P wave, and tall T wave.
Acute Tubular Necrosis Treatment
Here we are, acute tubular necrosis treatment. These treatments can help patient with acute tubular necrosis in reducing mortality or kidney failure. So these are the treatments clinically;
1. Diuretic and Fluid Infusion
Diuretic and fluid infusion in high volume will rinse tubular structure of cellular casts and debris, and replace the loss fluid. For long-term management of fluid loss with insensible water loss must replace every day
2. Red Blood Cell (RBC) Transfusion
RBC transfusion is only for patient with anemia complication.
Antibiotic is prescribed for prevention or treat the infections.
4. Intravenous Treatment
50 % glucose, regular insulin, and intravenous natrium bicarbonate to correct hyperkalemia
5. Polystyrene Sulfonate Natrium
Polystyrene sulfonate natrium combined with sorbitol can be given or prescribed to decrease extracellular potacium.
Peritoneal dialysis or hemodialysis can be done if patient in catabolic circumstance.
- Assess the cardiovascular status and respiratory, report if there are changes.
- Accurately, note intake and output of patient, include wound drainage, nasogastric output, and peritoneal dialysis or dialysis balance. Measure the body weight of patient every day. Look at excessive fluid intake of patient.
- Monitor hemoglobin and hematocryte, give blood product as prescribed. Pay attention to sign and symptoms of transfusion reaction like fever, skin eruption, and tremor. If those signs and symptoms are in patient, stop the transfusion immediately.
- Give medication as needed and prescribed
- Monitor laboratory result and aware of imbalance electrolyte level.
- Suggest patient to do right diet ( natrium and kalium limitation like banana, orange juice, and potato)
- To maintain anabolic status, give enough calorie and amino acid, and limit protein diet. Total parenteral nutrition status can be showed if patient looked so fatigue or in catabolic circumstance.
- Pay attention to renal perfusion problem like hypo tension and low urine output.
- Instruct patient to cough and deep breathing to prevent pulmonary complication
- Do passive range of motion. Help patient to walk immediately but don’t let the patient feel so fatigue
- Skin care is better to do by lotion application so that skin will still moist and healthy
- Give patient emotional support. Ask them to show the feeling about medication.