Mechanisms of Renal Fibrosis

Annu Rev Physiol. 2018 Feb 10:80:309-326. doi: 10.1146/annurev-physiol-022516-034227. Epub 2017 Oct 25.


Tubulointerstitial fibrosis is a chronic and progressive process affecting kidneys during aging and in chronic kidney disease (CKD), regardless of cause. CKD and renal fibrosis affect half of adults above age 70 and 10% of the world's population. Although no targeted therapy yet exists to slow renal fibrosis, a number of important recent advances have clarified the cellular and molecular mechanisms underlying the disease. In this review, I highlight these advances with a focus on cells and pathways that may be amenable to therapeutic targeting. I discuss pathologic changes regulating interstitial myofibroblast activation, including profibrotic and proinflammatory paracrine signals secreted by epithelial cells after either acute or chronic injury. I conclude by highlighting novel therapeutic targets and approaches with particular promise for development of new treatments for patients with fibrotic kidney disease.

Keywords: dedifferentiation; fibrosis; mesenchymal stem cell; myofibroblast; pericyte.

Publication types

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

MeSH terms

  • Animals
  • Cell Dedifferentiation / physiology
  • Disease Progression
  • Fibrosis / pathology*
  • Humans
  • Kidney Diseases / pathology*
  • Pericytes / pathology*