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Relationship: 1676


The title of the KER should clearly define the two KEs being considered and the sequential relationship between them (i.e., which is upstream and which is downstream). Consequently all KER titles take the form “upstream KE leads to downstream KE”.  More help

Increase, Cytotoxicity (renal tubular cell) leads to Occurrence, Kidney toxicity

Upstream event
Upstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help
Downstream event
Downstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help

Key Event Relationship Overview

The utility of AOPs for regulatory application is defined, to a large extent, by the confidence and precision with which they facilitate extrapolation of data measured at low levels of biological organisation to predicted outcomes at higher levels of organisation and the extent to which they can link biological effect measurements to their specific causes. Within the AOP framework, the predictive relationships that facilitate extrapolation are represented by the KERs. Consequently, the overall WoE for an AOP is a reflection in part, of the level of confidence in the underlying series of KERs it encompasses. Therefore, describing the KERs in an AOP involves assembling and organising the types of information and evidence that defines the scientific basis for inferring the probable change in, or state of, a downstream KE from the known or measured state of an upstream KE. More help

AOPs Referencing Relationship

This table is automatically generated upon addition of a KER to an AOP. All of the AOPs that are linked to this KER will automatically be listed in this subsection. Clicking on the name of the AOP in the table will bring you to the individual page for that AOP. More help
AOP Name Adjacency Weight of Evidence Quantitative Understanding Point of Contact Author Status OECD Status
Inhibition of mitochondrial DNA polymerase gamma leading to kidney toxicity adjacent High Moderate Angela Mally (send email) Under development: Not open for comment. Do not cite Under Development
Receptor mediated endocytosis and lysosomal overload leading to kidney toxicity adjacent High Moderate Angela Mally (send email) Under development: Not open for comment. Do not cite Under Development
Renal protein alkylation leading to kidney toxicity adjacent High Moderate Angela Mally (send email) Not under active development Under Development
Inhibition of mitochondrial electron transport chain (ETC) complexes leading to kidney toxicity adjacent Not Specified Not Specified Baki Sadi (send email) Under development: Not open for comment. Do not cite

Taxonomic Applicability

Select one or more structured terms that help to define the biological applicability domain of the KER. In general, this will be dictated by the more restrictive of the two KEs being linked together by the KER. Authors can indicate the relevant taxa for this KER in this subsection. The process is similar to what is described for KEs (see pages 30-31 and 37-38 of User Handbook) More help

Sex Applicability

Authors can indicate the relevant sex for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of the User Handbook). More help

Life Stage Applicability

Authors can indicate the relevant life stage for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of User Handbook). More help

Key Event Relationship Description

Provide a brief, descriptive summation of the KER. While the title itself is fairly descriptive, this section can provide details that aren’t inherent in the description of the KEs themselves (see page 39 of the User Handbook). This description section can be viewed as providing the increased specificity in the nature of upstream perturbation (KEupstream) that leads to a particular downstream perturbation (KEdownstream), while allowing the KE descriptions to remain generalised so they can be linked to different AOPs. The description is also intended to provide a concise overview for readers who may want a brief summation, without needing to read through the detailed support for the relationship (covered below). Careful attention should be taken to avoid reference to other KEs that are not part of this KER, other KERs or other AOPs. This will ensure that the KER is modular and can be used by other AOPs. More help

Excessive renal tubular cytotoxicity, both apoptotic and necrotic, leads to the eventual failure of the kidneys (Priante et al., 2019). This is because the mass cytotoxicity of renal tubular cells leads to the inability of the nephrons to properly filter nutrients and waste from the blood (Pirante et al., 2019). The kidneys can make compensational adjustments to the nephrons to continue adequate filtration up to the loss of 75% of the nephrons, beyond this amount of nephron loss, the kidneys lose function (Orr and Bridges, 2017).

Evidence Supporting this KER

Assembly and description of the scientific evidence supporting KERs in an AOP is an important step in the AOP development process that sets the stage for overall assessment of the AOP (see pages 49-56 of the User Handbook). To do this, biological plausibility, empirical support, and the current quantitative understanding of the KER are evaluated with regard to the predictive relationships/associations between defined pairs of KEs as a basis for considering WoE (page 55 of User Handbook). In addition, uncertainties and inconsistencies are considered. More help
Biological Plausibility
Define, in free text, the biological rationale for a connection between KEupstream and KEdownstream. What are the structural or functional relationships between the KEs? For example, there is a functional relationship between an enzyme’s activity and the product of a reaction it catalyses. Supporting references should be included. However, it is recognised that there may be cases where the biological relationship between two KEs is very well established, to the extent that it is widely accepted and consistently supported by so much literature that it is unnecessary and impractical to cite the relevant primary literature. Citation of review articles or other secondary sources, like text books, may be reasonable in such cases. The primary intent is to provide scientifically credible support for the structural and/or functional relationship between the pair of KEs if one is known. The description of biological plausibility can also incorporate additional mechanistic details that help inform the relationship between KEs, this is useful when it is not practical/pragmatic to represent these details as separate KEs due to the difficulty or relative infrequency with which it is likely to be measured (see page 40 of the User Handbook for further information).   More help

Renal tubular cells are very important functional units of the nephrons (Priante et al., 2019). The tubular cells are essential for the proper removal of waste material from the blood, as well as retaining essential nutrients, water, and salt levels for homeostatic blood content (Priante et al., 2019). The S3 segment of the proximal tubule in particular is highly susceptible to damage by environmental toxicants (Lentini et al., 2017). Apoptosis is the preferred method of cell death for renal tubule cells, as injured cells need to be removed without inducing an inflammatory response (Priante et al., 2019). By forming apoptotic bodies that can be recycled via phagocytes or epithelial cells, the kidney avoids the induction of an inflammatory response which causes the injury of surrounding, healthy cells. However, when apoptotic bodies are not phagocytosed quickly enough, their membranes can become damaged. This causes the apoptotic bodies to enter secondary necrosis, lysing and releasing their contents to the extracellular space. The immune cells will instigate an inflammatory response as a result, causing the injury to nearby tubular cells through the release of granule contents of by the immune cells (Priante et al., 2019). Remarkably, thanks to compensatory functional, molecular, and structural changes in the kidney, the remaining healthy nephrons are able to function adequately until more than 75% of them die (Orr and Bridges, 2017). After the loss of more than 75% of the nephrons however the remaining nephrons are no longer able to effectively remove environmental toxicants or waste from the filtrate, resulting in failed renal function (Orr and Bridges, 2017).

Uncertainties and Inconsistencies
In addition to outlining the evidence supporting a particular linkage, it is also important to identify inconsistencies or uncertainties in the relationship. Additionally, while there are expected patterns of concordance that support a causal linkage between the KEs in the pair, it is also helpful to identify experimental details that may explain apparent deviations from the expected patterns of concordance. Identification of uncertainties and inconsistencies contribute to evaluation of the overall WoE supporting the AOPs that contain a given KER and to the identification of research gaps that warrant investigation (seep pages 41-42 of the User Handbook).Given that AOPs are intended to support regulatory applications, AOP developers should focus on those inconsistencies or gaps that would have a direct bearing or impact on the confidence in the KER and its use as a basis for inference or extrapolation in a regulatory setting. Uncertainties that may be of academic interest but would have little impact on regulatory application don’t need to be described. In general, this section details evidence that may raise questions regarding the overall validity and predictive utility of the KER (including consideration of both biological plausibility and empirical support). It also contributes along with several other elements to the overall evaluation of the WoE for the KER (see Section 4 of the User Handbook).  More help

There are no currently known inconsistencies or uncertainties for this relationship.

Response-response Relationship
This subsection should be used to define sources of data that define the response-response relationships between the KEs. In particular, information regarding the general form of the relationship (e.g., linear, exponential, sigmoidal, threshold, etc.) should be captured if possible. If there are specific mathematical functions or computational models relevant to the KER in question that have been defined, those should also be cited and/or described where possible, along with information concerning the approximate range of certainty with which the state of the KEdownstream can be predicted based on the measured state of the KEupstream (i.e., can it be predicted within a factor of two, or within three orders of magnitude?). For example, a regression equation may reasonably describe the response-response relationship between the two KERs, but that relationship may have only been validated/tested in a single species under steady state exposure conditions. Those types of details would be useful to capture.  More help

There is a defined response-response relationship for renal tubule cytotoxicity leading to kidney failure. The loss of 75% of the nephrons to damage is the threshold for kidney failure (Orr and Bridges, 2017). This is due to the ability of the kidneys to make changes in the structure and function of the remaining nephrons at a molecular level to compensate for the lost nephrons (Orr and Bridges, 2017). The kidneys are able to retain adequate functioning until only 25% of the original nephrons remain, at which point the compensatory changes cannot maintain kidney functioning and kidney failure is final (Orr and Bridges, 2017).

This sub-section should be used to provide information regarding the approximate time-scale of the changes in KEdownstream relative to changes in KEupstream (i.e., do effects on KEdownstream lag those on KEupstream by seconds, minutes, hours, or days?). This can be useful information both in terms of modelling the KER, as well as for analyzing the critical or dominant paths through an AOP network (e.g., identification of an AO that could kill an organism in a matter of hours will generally be of higher priority than other potential AOs that take weeks or months to develop). Identification of time-scale can also aid the assessment of temporal concordance. For example, for a KER that operates on a time-scale of days, measurement of both KEs after just hours of exposure in a short-term experiment could lead to incorrect conclusions regarding dose-response or temporal concordance if the time-scale of the upstream to downstream transition was not considered. More help
Known modulating factors
This sub-section presents information regarding modulating factors/variables known to alter the shape of the response-response function that describes the quantitative relationship between the two KEs (for example, an iodine deficient diet causes a significant increase in the slope of the relationship; a particular genotype doubles the sensitivity of KEdownstream to changes in KEupstream). Information on these known modulating factors should be listed in this subsection, along with relevant information regarding the manner in which the modulating factor can be expected to alter the relationship (if known). Note, this section should focus on those modulating factors for which solid evidence supported by relevant data and literature is available. It should NOT list all possible/plausible modulating factors. In this regard, it is useful to bear in mind that many risk assessments conducted through conventional apical guideline testing-based approaches generally consider few if any modulating factors. More help

There are several known modulating factors of the relationship between renal tubular cytotoxicity and kidney failure. One modulator of this relationship is age. 

Known Feedforward/Feedback loops influencing this KER
This subsection should define whether there are known positive or negative feedback mechanisms involved and what is understood about their time-course and homeostatic limits? In some cases where feedback processes are measurable and causally linked to the outcome, they should be represented as KEs. However, in most cases these features are expected to predominantly influence the shape of the response-response, time-course, behaviours between selected KEs. For example, if a feedback loop acts as compensatory mechanism that aims to restore homeostasis following initial perturbation of a KE, the feedback loop will directly shape the response-response relationship between the KERs. Given interest in formally identifying these positive or negative feedback, it is recommended that a graphical annotation (page 44) indicating a positive or negative feedback loop is involved in a particular upstream to downstream KE transition (KER) be added to the graphical representation, and that details be provided in this subsection of the KER description (see pages 44-45 of the User Handbook).  More help

There are no known feedforward/feedback loops that influence this relationship.

Domain of Applicability

As for the KEs, there is also a free-text section of the KER description that the developer can use to explain his/her rationale for the structured terms selected with regard to taxonomic, life stage, or sex applicability, or provide a more generalizable or nuanced description of the applicability domain than may be feasible using standardized terms. More help

The domain of applicability only includes vertebrates, as invertebrates and non-animals do not have kidneys (Mahasen, 2016).


List of the literature that was cited for this KER description using the appropriate format. Ideally, the list of references should conform, to the extent possible, with the OECD Style Guide (OECD, 2015). More help

Lentini, P., Zanoli, L., Granata, A., Signorelli, S. S., Castellino, P., & Dell'aquila, R. (2017).

Kidney and heavy metals - the role of environmental exposure (review). Molecular Medicine Reports, 15(3413), 3419. doi:10.3892/mmr.2017.6389

Mahasen, L. M. A. (2016). Evolution of the kidney. Anatomy Physiol. Biochem. Int. J., 1(1),

555554. doi:10.19080/APBIJ.2016.01.555554

Orr, S. E., & Bridges, C. C. (2017). Chronic kidney disease and exposure to nephrotoxic

metals. International Journal of Molecular Sciences, 18 doi:10.3390/ijms18051039

Priante, G., Gianesello, L., Ceol, M., Del Prete, D., & Anglani, F. (2019). Cell death in the

kidney. International Journal of Molecular Sciences, 20(14), 3598. doi: 10.3390/ijms20143598. doi:10.3390/ijms20143598

Sano, K., Fujigaki, Y., Miyaji, T., Ikegaya, N., Ohishi, K., Yonemura, K., & Hishida, A. (2000).

Role of apoptosis in uranyl acetate-induced acute renal failure and acquired resistance to uranyl acetate. Kidney International, 57(4), 1560-1570. doi:10.1046/j.1523-1755.2000.00777.x