[Applause] [Music] hi this is tom from zero2finals.com in this video i'm going to be talking to you about acute tubular necrosis and you can find written notes on this topic at zero to finals dot com slash a t n or in the renal section of the zero to finals medicine book so let's jump straight in acute tubular necrosis is damage and death remember death we call necrosis of the epithelial cells of the renal tubules and these are the cells that line the tubules this is the most common cause of acute kidney injury damage to the kidney cells occurs due to ischemia or due to toxins the epithelial cells have the ability to regenerate which means that acute tubular necrosis is reversible and it usually takes 7 to 21 days to make a full recovery so what are the causes of acute tubular necrosis well the ischemia that leads to the necrosis of the epithelial cells can occur secondary to hypoperfusion so a low perfusion with blood in shock or in sepsis or in severe dehydration direct damage can also result from toxins which occur due to radiology contrast dyes so a patient might go for a ct scan where they have a contrast dye injected which damages the epithelial cells and leads to acute tubulin necrosis it might be toxins like gentamycin and non-steroidal anti-inflammatory drugs like naproxen can also cause acute tubular necrosis it's worth remembering when you do a urinalysis investigation in a patient who has acute tubulin necrosis you can find something called muddy brown casts and this is a patho-mnemonic finding which is specific to acute tubular necrosis and remember that patho-mnemonic basically means that it's a finding that you only see in one specific condition and in acute tubular necrosis you find muddy brown casts so if you see this on your analysis in your exams you know what the diagnosis is they can also be renal tubular epithelial cells that have broken away and passed into the urine so how do we manage acute tubular necrosis well the treatment is the same as with other causes of acute kidney injury it's with supportive management intravenous fluids to correct any dehydration and to help refuse the kidneys properly stopping any nephrotoxic medications such as non-steroidal anti-inflammatories or gentamicin and treating any complications of the condition thank you for watching this video if you liked the video left a comment or subscribe to the channel thank you so much it really helps zero to finals is not just a youtube channel there's also a website with detailed notes illustrations and questions an instagram account where new questions are posted every day to help you test your knowledge books flash cards and much more i also have a personal channel where i share my thoughts and tips on learning medicine and you can find links to everything in the description of this video see you next time