The Significance of NAD+ Biosynthesis Alterations in Acute Kidney Injury

Amanda J. Clark, Marie Christelle Saade, Samir M. Parikh

Research output: Contribution to journalReview articlepeer-review


Acute kidney injury (AKI) is a serious and highly prevalent disease, yet only supportive treatment is available. Nicotinamide adenine dinucleotide (NAD+) is a cofactor necessary for adenosine triphosphate (ATP) production and cell survival. Changes in renal NAD+ biosynthesis and energy utilization are features of AKI. Targeting NAD+ as an AKI therapy shows promising potential. However, the pursuit of NAD+-based treatments requires deeper understanding of the unique drivers and effects of the NAD+ biosynthesis derangements that arise in AKI. This article summarizes the NAD+ biosynthesis alterations in the kidney in AKI, chronic disease, and aging. To enhance this understanding, we explore instances of NAD+ biosynthesis alterations outside the kidney in inflammation, pregnancy, and cancer. In doing so, we seek to highlight that the different NAD+ biosynthesis pathways are not interconvertible and propose that the way in which NAD+ is synthesized may be just as important as the NAD+ produced.

Original languageEnglish (US)
Article number151287
JournalSeminars in nephrology
Issue number3
StatePublished - May 2022
Externally publishedYes


  • AKI
  • cancer
  • metabolism
  • NAD+
  • NAD+ biosynthesis
  • pregnancy

ASJC Scopus subject areas

  • Nephrology


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