2.2.2. Oxidative Stress

Oxidative stress occurs when there is a disruption in the balance of free radicals and antioxidants that degrade those free radicals [46]. ROS and reactive nitrogen species (RNS) are generated during oxidative phosphorylation [47]. Under normal conditions, moderate concentrations of ROS/RNS act as second messengers that regulate signal transduction pathways [48]. Mitochondrial dysregulation increases the production of ROS beyond the normal levels, which depletes antioxidants and leads to oxidative stress [46]. Increased ROS leads to lipid, DNA, and protein oxidation, which cause the formation of complex radical intermediates [46]. These highly reactive intermediates trigger the secretion of pro-inflammatory mediators during active inflammation [49]. Inflammatory cytokines, such as IL-6 and TNF-α, promote renal injury by perpetuating dysregulation in cellular processes [47]. Therefore, oxidative stress exacerbates cellular damage and enhances the progression of CKD [46].
