Fluid resuscitation for oliguria rescue in septic acute kidney injury (AKI) has limited success. By examination of the proximal tubular integrity, Nakano et al. identified paracellular renal filtrate leakage in proximal tubules after lipopolysaccharide induced tight junction disruption to contribute to oliguria. Suppression of lipopolysaccharide injury to proximal tubules by Toll-like receptor 4 knockout significantly ameliorated the oliguria and renal function loss in septic AKI. This commentary discusses the new therapeutic strategy for septic AKI rescue by proximal tubular integrity protection and the potential impact of tight junction injury in all AKI conditions.
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