*Review* **Molecular Mechanisms of Cellular Injury and Role of Toxic Heavy Metals in Chronic Kidney Disease**

**Manish Mishra <sup>1</sup> , Larry Nichols 2, Aditi A. Dave 1, Elizabeth H Pittman 1, John P. Cheek 1, Anasalea J. V. Caroland 1, Purva Lotwala 1, James Drummond <sup>1</sup> and Christy C. Bridges 1,\***

	- Macon, GA 31207, USA

**Abstract:** Chronic kidney disease (CKD) is a progressive disease that affects millions of adults every year. Major risk factors include diabetes, hypertension, and obesity, which affect millions of adults worldwide. CKD is characterized by cellular injury followed by permanent loss of functional nephrons. As injured cells die and nephrons become sclerotic, remaining healthy nephrons attempt to compensate by undergoing various structural, molecular, and functional changes. While these changes are designed to maintain appropriate renal function, they may lead to additional cellular injury and progression of disease. As CKD progresses and filtration decreases, the ability to eliminate metabolic wastes and environmental toxicants declines. The inability to eliminate environmental toxicants such as arsenic, cadmium, and mercury may contribute to cellular injury and enhance the progression of CKD. The present review describes major molecular alterations that contribute to the pathogenesis of CKD and the effects of arsenic, cadmium, and mercury on the progression of CKD.

**Keywords:** chronic kidney disease; heavy metals; cadmium; mercury; arsenic; cellular injury
