Molecular Basis of Oxidative Stress-Induced Acute Kidney Injury, Kidney Fibrosis, Chronic Kidney Disease, and Clinical Significance of Targeting Reactive Oxygen Species-Regulated Pathways to Treat Kidney Disease.

Kidney disease is a growing public health problem globally. Multiple or repeated acute injuries to the kidney due to chronic exposure to toxicants promote the development of chronic kidney disease (CKD), an irreversible disease for which there is no current treatment. Renal fibrosis, characterized by glomerulosclerosis and tubulointerstitial fibrosis, is a well-known pathological stage during the progression of acute kidney injury (AKI) to CKD. Over the years, tremendous progress has been made in understanding the regulatory molecules involved in kidney fibrosis; however, there are currently no effective therapies for treating renal fibrosis. The mechanism involved in the transition of AKI to fibrosis and its progression to CKD involves various pathological changes, including cellular remodeling. At the molecular level, these pathological features are mediated by changes in the expression of genes and signaling pathways that control cellular dedifferentiation. Meanwhile, the generation of oxidative stress is a common feature of nephrotoxicants. Thus, the kidneys are highly susceptible to oxidative stress-induced injury, and accumulating evidence suggests that oxidative stress plays a causative role in the development of kidney disease. Oxidative stress has been shown to modulate various signaling pathways associated with AKI and fibrogenic changes in the kidney. Accumulating evidence suggests that targeting oxidative stress through antioxidants and/or inhibitors of reactive oxygen species (ROS)-regulated pathways holds promise for the clinical management of this disease, for which there is currently no effective therapy. This review summarizes the research development that provides a mechanistic perspective on the role of oxidative stress in regulating of target genes and signaling pathways associated with AKI and CKD. Additionally, recent reports highlighting the clinical significance of targeting oxidative stress for the treatment of CKD are discussed.