All three upstream signaling pathways that mediate ER stress, including the inositol requiring kinase 1α/X-box-binding protein 1, activating transcription factor (ATF)6, and protein kinase-like ER kinase/eukaryotic translation initiation factor 2/ATF4 pathways, intersect at the transcription factor C/EBP homologous protein (CHOP) to initiate apoptosis and inflammation.11, 12 Previous studies have demonstrated that ER stress was involved in various diseases, including cardiovascular diseases,10 obesity,13 acute kidney injury (AKI)14 and so on. Here, ATF4 is linked to acute kidney injury.