Acute tubular necrosis is a kidney disorder involving damage to the tubule cells of the kidneys, which can lead to acute kidney failure. Reversible or irreversible type of renal failure caused by ischemic or toxic injury to the renal tubular epithelial cells. The injury results in cell death or detachment from basement membrane causing tubular dysfunction. Acute tubular necrosis (ATN) is usually caused by a lack of oxygen to the kidney tissues (ischemia of the kidneys). It may also occur if the kidney cells are damaged by a poison or harmful substance. 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 that can lead to acute renal failure. ATN is one of the most common causes of kidney failure in hospitalized patients. Risks for acute tubular necrosis include: Blood transfusion reaction; Injury or trauma that damages the muscles; Low blood pressure (hypotension) that lasts longer than 30 minutes; Recent major surgery; Septic shock due to severe infection; Liver disease and kidney damage caused by diabetes (diabetic nephropathy) may make a person more susceptible to the condition. ATN can also be caused by: Dye (contrast) used for x-ray (radiology) studies; Medications that are toxic to the kidneys (such as aminoglycoside antibiotics or amphotericin)