Table 3.

Major pathways for heme protein-induced renal injury

Pathway	Relevant Heme Protein	Mechanism of Injury
Destabilization of HPs	Cytochrome p450, others	Heme/Fe-mediated
Cellular egress and delivery to the kidney	Myoglobin, hemoglobin	See Figure 1
Autoxidation of HPs	Myoglobin, hemoglobin	See Figure 2
Aberrant/inordinate HP activation	iNOS, NADPH oxidase	ROS, RNS
Mitochondrial release into the cytosol	Cytochrome c	Apoptosis
Neutrophil/monocyte degranulation	Myeloperoxidase	ROS, hypohalous acid, NETs

HPs, heme proteins; ROS, reactive oxygen species; RNS, reactive nitrogen species; NET, neutrophil extracellular traps.