定期和适度的运动可用于治疗多种疾病，包括癌症、心血管疾病、关节炎，甚至慢性肾病 (CKD)。相反，由于体育锻炼对身体生理机能的严重影响，长期以来一直被指出是急性肾损伤（AKI）的根源之一。 AKI 的发展与肾小管坏死增加有关，从而引发一系列炎症反应。后者涉及细胞因子的产生、免疫细胞（巨噬细胞、淋巴细胞和中性粒细胞等）激活和氧化应激增加。 AKI 可诱导长期纤维化刺激，导致 CKD 发展。 AKI 的替代疗法的需求仍然是一个相关问题。在这种情况下，出现了一个问题：适度的、非情有可原的运动是否可以在某种程度上预防 AKI。多项研究表明，适度运动有助于减少组织损伤并促进急性损伤后肾脏功能的恢复。特别是，可以通过运动来调节免疫系统，从而更好地从不同的病症中恢复过来。在这篇综述中，我们的目的是探讨运动在不同情况下作为炎症/免疫系统调节剂在 AKI 预防或恢复中的作用，而不是作为 AKI 的触发因素。在由缺血和再灌注、脓毒症、糖尿病、抗生素或化疗引起的 AKI 中，定期和/或适度的运动可以调节免疫系统，使其产生更具调节性的免疫反应，通常呈现抗炎特​​征。运动被证明可以减少氧化应激、炎症标志物（Caspase-3、乳酸脱氢酶和一氧化氮）、炎症细胞因子（白细胞介素 (IL)-1b、IL-6、IL-8 和肿瘤坏死因子-α (TNF- α))，将淋巴细胞调节为免疫抑制表型，并减少肿瘤坏死因子-β (TGF-β)（一种与纤维化发展相关的细胞因子）。因此，它创造了一个组织损伤、缺氧、细胞凋亡或纤维化较少的 AKI 恢复环境。总之，定期进行适度的体育锻炼会对免疫系统产生影响，有利于调节和抗炎作用，从而预防 AKI 的发生和/或协助 AKI 的恢复。 AKI 患者应考虑适度运动作为补充疗法。版权所有 © 2023 Costanti-Nascimento、Brelaz-Abreu、Bragança-Jardim、Pereira、Camara 和 Amano。

Regular and moderate exercise is being used for therapeutic purposes in treating several diseases, including cancer, cardiovascular diseases, arthritis, and even chronic kidney diseases (CKDs). Conversely, extenuating physical exercise has long been pointed out as one of the sources of acute kidney injury (AKI) due to its severe impact on the body's physiology. AKI development is associated with increased tubular necrosis, which initiates a cascade of inflammatory responses. The latter involves cytokine production, immune cell (macrophages, lymphocytes, and neutrophils, among others) activation, and increased oxidative stress. AKI can induce prolonged fibrosis stimulation, leading to CKD development. The need for therapeutic alternative treatments for AKI is still a relevant issue. In this context arises the question as to whether moderate, not extenuating, exercise could, on some level, prevent AKI. Several studies have shown that moderate exercise can help reduce tissue damage and increase the functional recovery of the kidneys after an acute injury. In particular, the immune system can be modulated by exercise, leading to a better recovery from different pathologies. In this review, we aimed to explore the role of exercise not as a trigger of AKI, but as a modulator of the inflammatory/immune system in the prevention or recovery from AKI in different scenarios. In AKI induced by ischemia and reperfusion, sepsis, diabetes, antibiotics, or chemotherapy, regular and/or moderate exercise could modulate the immune system toward a more regulatory immune response, presenting, in general, an anti-inflammatory profile. Exercise was shown to diminish oxidative stress, inflammatory markers (caspase-3, lactate dehydrogenase, and nitric oxide), inflammatory cytokines (interleukin (IL)-1b, IL-6, IL-8, and tumor necrosis factor-α (TNF-α)), modulate lymphocytes to an immune suppressive phenotype, and decrease tumor necrosis factor-β (TGF-β), a cytokine associated with fibrosis development. Thus, it creates an AKI recovery environment with less tissue damage, hypoxia, apoptosis, or fibrosis. In conclusion, the practice of regular moderate physical exercise has an impact on the immune system, favoring a regulatory and anti-inflammatory profile that prevents the occurrence of AKI and/or assists in the recovery from AKI. Moderate exercise should be considered for patients with AKI as a complementary therapy.Copyright © 2023 Costanti-Nascimento, Brelaz-Abreu, Bragança-Jardim, Pereira, Camara and Amano.