Figure 5.

IS-induced oxidative stress is associated with renal anemia. IS-induced NOX activation mediates ROS generation, which directly induces apoptotic cell death of RBCs (eryptosis), and also increases hepatic hepcidin production to block ferroportin-dependent iron efflux from iron storage—such as duodenal enterocytes, macrophages of the reticuloendothelial system, and hepatocytes. IS: indoxyl sulfate; NOX4: nicotinamide adenine dinucleotide phosphate oxidase 4; ROS: reactive oxygen species.