Novel targets of antifibrotic and anti-inflammatory treatment in CKD

Nat Rev Nephrol. 2014 May;10(5):257-67. doi: 10.1038/nrneph.2014.31. Epub 2014 Mar 25.


Chronic kidney disease (CKD) is becoming a worldwide epidemic, driven largely by the dramatic rise in the prevalence of diabetes and obesity. Novel targets and treatments for CKD are, therefore, desperately needed-to both mitigate the burden of this disease in the general population and reduce the necessity for renal replacement therapy in individual patients. This Review highlights new insights into the mechanisms that contribute to CKD, and approaches that might facilitate the development of disease-arresting therapies for CKD. Particular focus is given to therapeutic approaches using antifibrotic agents that target the transforming growth factor β superfamily. In addition, we discuss new insights regarding the roles of vascular calcification, the NADPH oxidase family, and inflammation in the pathogenesis of CKD. We also highlight a new understanding regarding kidney energy sensing pathways (AMPK, sirtuins, and mTOR) in a variety of kidney diseases and how they are linked to inflammation and fibrosis. Finally, exciting new insights have been made into the role of mitochondrial function and mitochondrial biogenesis in relation to progressive kidney disease. Prospective therapeutics based on these findings will hopefully renew hope for clinicians and patients in the near future.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • AMP-Activated Protein Kinases / physiology
  • Animals
  • Anti-Inflammatory Agents / therapeutic use*
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetes Mellitus, Type 2 / physiopathology
  • Disease Progression
  • Fibroblast Growth Factors / physiology
  • Fibrosis
  • Glucuronidase / therapeutic use
  • Humans
  • Mitochondria / physiology
  • Models, Animal
  • NADPH Oxidases / antagonists & inhibitors
  • NADPH Oxidases / physiology
  • NF-kappa B / antagonists & inhibitors
  • NF-kappa B / physiology
  • Renal Insufficiency, Chronic / drug therapy*
  • Transforming Growth Factor beta / antagonists & inhibitors
  • Transforming Growth Factor beta / immunology
  • Transforming Growth Factor beta / physiology
  • Vascular Calcification


  • Anti-Inflammatory Agents
  • NF-kappa B
  • Transforming Growth Factor beta
  • Fibroblast Growth Factors
  • fibroblast growth factor 23
  • NADPH Oxidases
  • AMP-Activated Protein Kinases
  • Glucuronidase
  • klotho protein