Micro RNAs in septic acute kidney injury: pathophysiology, biomarkers and therapeutic targets

Introduction : Septic acute kidney injury (S-AKI) is a life-threatening complication of sepsis with high mortality and limited treatment options. Emerging evidence highlights the role of microRNAs (miRNAs) as critical regulators of the key pathogenic pathways involved in S-AKI, including inflammation, apoptosis, oxidative stress, and microvascular dysfunction. Aim : To provide a comprehensive overview of the current knowledge of miRNA involvement in the pathophysiology, diagnosis, and potential treatment of S-AKI. Materials and methods : A structured literature review was conducted using recent experimental and clinical studies published in peer-reviewed journals from 2018 to 2025. Key miRNAs implicated in S-AKI were identified and analyzed for their diagnostic and therapeutic relevance. Results : Several miRNAs, such as miR-155, miR-146a/b, miR-21, miR-210, and miR-22-3p, modulate essential signaling cascades in S-AKI, either promoting or attenuating kidney injury depending on context. Circulating and urinary miRNAs demonstrate high sensitivity and specificity as early biomarkers, often outperforming traditional markers like serum creatinine. Furthermore, experimental models show that targeting specific miRNAs using mimics or antagonists can significantly mitigate renal damage in sepsis. Conclusion : miRNAs offer a promising dual application in S-AKI—as sensitive noninvasive biomarkers and as novel therapeutic targets. Future research should focus on validating their clinical utility and overcoming challenges related to targeted delivery and off-target effects. miRNA-based interventions may become integral components of personalized therapy in sepsis-related kidney injury.