Metabolic Acidosis of CKD: An Update Jeffrey A. Kraut, MD, Nicolaos E. Madias, MD  American Journal of Kidney Diseases  Volume 67, Issue 2, Pages 307-317 (February 2016) DOI: 10.1053/j.ajkd.2015.08.028 Copyright © 2016 Terms and Conditions

Figure 1 Putative factors induced by metabolic acidosis producing kidney injury and accelerating the progression of chronic kidney disease (CKD). Acidosis increases the production of aldosterone, endothelin, and angiotensin II, factors involved in promoting kidney injury and fibrosis. Metabolic acidosis is associated with increased renal ammonia production. This process activates complement, leading to injury and fibrosis. Finally, exposure to an acidic environment stimulates various proinflammatory cytokines, which also could lead to kidney injury and fibrosis. American Journal of Kidney Diseases 2016 67, 307-317DOI: (10.1053/j.ajkd.2015.08.028) Copyright © 2016 Terms and Conditions