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The most common causes of acute tubular necrosis (ATN) include sepsis and trauma. ATN is a condition characterized by damage to the tubular cells of the kidneys, often resulting from a lack of blood flow (ischemia) or direct injury to the renal tubules. Sepsis, a severe infection that can lead to systemic inflammation, often causes a significant drop in blood pressure and perfusion to the kidneys, leading to ischemic injury and subsequent ATN. Trauma can also contribute to ATN, especially if it results in significant blood loss or other factors that compromise renal blood flow.

In contrast, hypertension and diabetes are more closely associated with chronic renal conditions rather than the acute onset seen in ATN. Age and obesity, while they can influence overall kidney health and susceptibility to chronic kidney disease, do not specifically lead to the acute changes seen in tubular cells characteristic of ATN. Lastly, smoking and dietary habits can affect kidney function over the long term but are not primary causes of acute tubular necrosis. Therefore, sepsis and trauma stand out as the key factors leading to this acute kidney injury.