Acute tubular necrosis primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Effective measures for the primary prevention of acute tubular necrosis include identification of individuals who are at high risk and prompt treatment for underlying conditions, maintain volume status and adequate renal perfusion by proper hydration or isotonic fluid administration, monitoring fluid input and urine output, serum creatinine at regular intervals to ensure normal renal function. Avoiding or decreasing dose of nephrotoxins and contrast media can be done.

• Effective measures for the primary prevention of acute tubular necrosis include:
  • Identifying individuals who are at risk for developing acute tubular necrosis. Promptly treating conditions that can lead to decreased renal perfusion and/or decreased oxygen to the kidneys can reduce the risk of acute tubular necrosis. These include:^[1]
    • Patients who are undergoing for major surgery such as cardiac or abdominal surgery
    • Marked hypovolemia
    • Severe hypotension
    • Acute pancreatitis
    • shock and sepsis
    • Chronic renal disease
    • Critically ill and hospitalized individuals
    • Diabetes mellitus
  • Monitor serum creatinine and urine output regularly in high-risk individuals.
  • Avoiding or decreasing daily dose of nephrotoxins^[2]
  • Maintain volume status to ensure adequate renal blood flow by proper hydration or isotonic fluid administration.
  • Contrast media-induced acute tubular necrosis may be prevented with administration of isotonic saline along with radiocontrast substance.^[3]

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