Acute tubular necrosis (ATN) is caused by ischemia of the kidneys (lack of oxygen to the tissues), or by exposure to materials that are poisonous to the kidney (nephrotoxic agents).

The internal structures of the kidney, particularly the tissues of the kidney tubule, become damaged or destroyed. ATN is one of the most common structural changes associated with the development of acute renal failure.

ATN, along with prerenal azotemia are the most common causes of renal failure in hospitalized patients. Risks for acute tubular necrosis include injury or trauma with resulting damage to the muscles, recent major surgery, blood transfusion reaction, septic shock or other forms of shock, and severe hypotension (low blood pressure) that lasts longer than 30 minutes.

Any condition that causes a reduction in the amount of blood being pumped by the heart may cause ATN. Liver disease and damage caused by diabetes mellitus (diabetic nephropathy) may predispose a person to the condition.

ATN can be caused by exposure to nephrotoxic agents -- such as aminoglycoside antibiotics, antifungal agents -- such as amphotericin, medications to prevent rejection of transplanted organs -- such as cyclosporine, dye used for radiographic studies, and other substances.