Because the tubular cells continually replace themselves, the overall prognosis for ATN is quite good if the underlying cause is corrected, and recovery is likely within 7 to 21 days.
On histopathology, there is usually tubulorrhexis, that is, localized necrosis of the epithelial lining in renal tubules, with focal rupture or loss of basement membrane.
[6][7][8][9][10] Toxic ATN can be caused by free hemoglobin or myoglobin, by medication including antibiotics such as aminoglycoside,[11] statins such as atorvastatin, bisphosphonates like pamidronate[12] and cytotoxic drugs such as cisplatin, or by intoxication (ethylene glycol, "anti-freeze").
[2] Ischemic ATN can be caused when the kidneys are not sufficiently perfused for a long period of time (i.e. renal artery stenosis) or during shock.
Given their importance in massive nutrient and electrolyte reabsorption, the proximal tubule and medullary thick ascending limb require significant ATP and are most susceptible to ischemic damage.