Acute tubular necrosis (ATN) is renal tubule epithelial cell destruction resulting in acute kidney injury. It is most often caused by nephrotoxins and renal ischemia (impaired oxygenation of kidneys) and is characterized by elevated creatine and blood urea nitrogen (BUN). Other common signs and symptoms include nausea, vomiting, edema, oliguria, anuria, dehydration, malaise, and decreased consciousness (delirium, drowsiness, seizures, coma). Risk factors include prolonged hypotension (more than 30 minutes), major surgery, reaction to blood transfusion, traumatic damage to muscles, radiation contrast dye, nephrotoxic drugs, and diabetic nephropathy.

Management first targets rehydration and cessation of any causative agent. Prognosis is typically favorable due to the kidney's mechanism for replacement of tubular cells in approximately 1-3 weeks. In cases of severe kidney injury and complications (for example, extremely elevated serum potassium), dialysis may be necessary for supportive care.