Acute kidney injury and acute tubular necrosis
KDIGO definition and staging, why ATN happens and how it recovers, the hospital causes that dominate the exam, and what to do after discharge.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- AKI is an abrupt fall in kidney function, defined and staged by KDIGO 2012 on creatinine rise and urine output. It affects up to 1 in 5 adult inpatients and independently predicts death, CKD and readmission.
- Acute tubular necrosis (ATN) is the commonest intrinsic cause in hospital, usually from ischaemia (sepsis, shock, surgery) or nephrotoxins.
- Management is mostly supportive: restore perfusion, stop nephrotoxins, relieve obstruction, dose drugs for the actual GFR, and dialyse for complications.
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Sources
- KDIGO Clinical Practice Guideline for Acute Kidney Injury (Kidney International Supplements 2012;2:1-138)Kidney Disease Improving Global Outcomes, 2012 (2026 AKI/AKD update: public review completed, final not yet published)
- Kidney and Urinary (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Chronic Kidney Disease (CKD) Management in Primary Care, 5th editionAU/NZKidney Health Australia, 2024
- Acute kidney injury: prevention, detection and management (NICE guideline NG148)National Institute for Health and Care Excellence, 2019
- Finfer S et al. Balanced multielectrolyte solution versus saline in critically ill adults (PLUS). N Engl J Med 2022;386:815-26AU/NZNew England Journal of Medicine, 2022
- Wong F et al. Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome (CONFIRM). N Engl J Med 2021;384:818-28New England Journal of Medicine, 2021
- Nadim MK et al. Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting. J Hepatol 2024;81:163-83Journal of Hepatology, 2024
- AusPAR for terlipressin (Lucassin)AU/NZTherapeutic Goods Administration, 2013
- Last updated
- 14 November 2026
What changed
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