Acute Tubular Necrosis ATN

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Acute Tubular Necrosis (ATN)

• Slides without permission from
• Pathology of Acute kidney injury/Acute renal
  failure (Acute Nephritis, RPGN ATN, AIN)
• Pamela C. Gibson, MD
• Department of Pathology
• 2006

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ATN

• Acute decrease in GFR in setting of ischemia or
  toxins
• Patients may be oliguric or non-oliguric
• Urine- muddy brown casts, high urine Na
• Biopsy usually not necessary
• Supportive care
• Recovery of renal function 2-4 weeks

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One of the most important things to remember

• ATN is reversible if you identify the cause and
  stop it/ correct it.

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Pathology of ATN

• Dilated tubules
• Patchy flattened epithelium, loss of cells due to
  necrosis/sloughing, enlarged nuclei, mitoses
• Interstitial edema, scattered interstitial
  inflammatory cells
• Pigmented casts, granular casts, cellular casts

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Hemoglobin-pigmented (muddy brown) casts, found
in acute tubular necrosis
400x magnification
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Normal proximal tubules
Injured proximal tubules
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Normal proximal tubules
Injured proximal tubules
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Injured tubules
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HE stain
Dilated tubule
Interstitial edema
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HE stain
Dilated lumens, flattened cells, edema between
tubules
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PAS stain
Dilated lumens, flattened cells, loss of brush
border