Generally speaking acute tubular necrosis, there are two causes, nephrotoxicity and renal ischemia: 1. First of all, ischemia of the kidney, for example, there is upper gastrointestinal bleeding, nausea, vomiting, or cardiac failure leading to insufficient perfusion of the kidneys. When there is ischemia in the kidneys, our tubules become necrotic, and this is the first major cause; 2. The second major cause is poisoning, and poisoning consists of two parts, including endogenous some toxins and exogenous toxins. For example, exogenous toxins, we may often hear the people say, someone was stung by a bee, someone ate fish guts, someone was bitten by a snake, we are very common among some, such as drugs, including penicillin and cephalosporins may also appear. There are also aminoglycosides that can cause tubular necrosis, and these are what we call exogenous toxin-induced acute tubular necrosis; there are also endogenous acute tubular necrosis, such as hemoglobin hemolysis, myoglobin hemolysis, myoglobin hemolysis, and what do you see in myoglobin hemolysis? For example, we have rhabdomyolysis, which occurs when there is muscle necrosis after a major earthquake, marching, strenuous exercise, or cycling on a motorized bicycle, resulting in rhabdomyolysis. Patients with hemolysis can also lead to acute tubular necrosis caused by endogenous toxins.