From the Research
Steroids are not recommended for the treatment of acute tubular necrosis (ATN). The standard management of ATN focuses on supportive care, including maintaining adequate hydration, avoiding nephrotoxic agents, optimizing hemodynamics, and providing renal replacement therapy if necessary. Treatment should address the underlying cause, such as discontinuing nephrotoxic medications, treating infections, or improving cardiac output in cases of ischemic injury.
The pathophysiology of ATN involves direct cellular injury, tubular obstruction, and altered renal hemodynamics, none of which are primarily mediated by inflammation that would be targeted by steroids. Recovery from ATN typically occurs spontaneously with supportive care as the tubular cells regenerate over a period of days to weeks, and introducing steroids may potentially increase the risk of infection without providing benefit in the healing process.
Some studies have reported cases where steroids appeared to be beneficial in the treatment of ATN, such as a case report of a patient with recurrent ATN of unclear etiology who responded to steroids 1, and a case of Vanishing bile duct syndrome with ATN that improved with steroid treatment 2. However, these cases are exceptions rather than the rule, and the majority of the evidence suggests that steroids do not play a significant role in the treatment of ATN.
In fact, a study from 2012 found that the cause of ATN, whether pure ischemic, pure nephrotoxic, or mixed, has a profound impact on short- and long-term outcomes of critically-ill patients with AKI requiring renal replacement therapy 3. This study highlights the importance of addressing the underlying cause of ATN, rather than relying on steroid therapy.
Overall, the evidence suggests that steroids are not a recommended treatment for ATN, and that supportive care and addressing the underlying cause of the condition are the most effective ways to manage ATN and improve patient outcomes.