EDN1 and acute kidney tubular necrosis: In adults, acute tubular necrosis has been recently hypothesized to be secondary to endothelin-1 mediated vasoconstriction at the onset of proteinuria with a subsequent decrease in renal perfusion, further perpetuated by diuretic-induced hypovolemia, arteriolar nephrosclerosis, and exposure to nephrotoxic agents [16, 17].