AProlonged renal hypoperfusion is the most common cause of ATN

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b. Nephrotoxic agents (aminoglycosides, heavy metals, radiocontrast media, ethylene glycol) represent exogenous nephrotoxins. ATN may also occur as a result of endogenous nephrotoxins, such as intratubular pigments (hemoglobinuria), intratubular proteins (myeloma), and intratubular crystals (uric acid).

2. Acute interstitial nephritis (AIN) is an allergic reaction secondary to drugs (NSAIDs, p-lactams).

3. Arteriolar injury occurs secondary to hypertension, vasculitis, microangiopathic disorders.

4. Glomerulonephritis secondary to immunologically mediated inflammation may cause intrarenal damage.

C. Postrenal insult results from obstruction of urine flow. Postrenal insult is the least common cause of acute renal failure, accounting for 10%. Postrenal insult may be caused by obstruction secondary to prostate cancer, benign prostatic hypertrophy, or renal calculi. Postrenal insult may be caused by amyloidosis, uric acid crystals, multiple myeloma, methotrexate, or acyclovir.

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