Our previous studies have suggested a critical role of reticulon (RTN)1A in mediating endoplasmic reticulum (ER) stress in kidney cells of animal models and humans with kidney diseases. A large body of evidence suggests that proteinuria itself can cause tubular cell injury leading to the progression of kidney disease. In the present study, we determined whether RTN1A mediates proteinuria-induced tubular cell injury through increased ER stress. We found that incubation of HK2 cells with human serum albumin induced the expression of RTN1A and ER stress markers, whereas knockdown of RTN1A expression attenuated human serum albumin-induced ER stress and tubular cell apoptosis in vitro. In vivo, we found that tubular cell-specific RTN1 knockdown resulted in a significant attenuation of tubular cell ER stress, apoptosis, and renal fibrosis in a model of albumin overload nephropathy. Based on these findings, we conclude that RTN1A is a key mediator for proteinuria-induced tubular cell toxicity and renal fibrosis.reticulon-1; kidney disease; proteinuria; renal tubular cells; endoplasmic reticulum stress; apoptosis PROTEINURIA has been postulated to contribute to tubular cell injury and interstitial fibrosis (2,19). Studies have shown that patients with higher levels of proteinuria are at a greater risk of progression to end-stage renal disease (20,24). However, the underlying mechanisms of albumin-induced tubulointerstitial injury are not completely understood. Currently, there is no specific and effective therapy available to reduce the progression of chronic kidney disease (CKD) induced by proteinuria.Endoplasmic reticulum (ER) stress has been shown to contribute to the development and progression of CKD (9, 10). Cells respond to ER stress by activating the unfolded protein response (UPR), and glucose-regulated protein of 78 kDa (GRP78) serves as a central regulator of three main UPR sensors, namely, activating transcription factor (ATF)6, inositol-requiring enzyme (IRE)-1␣, and protein kinase RNA-like ER kinase (PERK), that initiate the UPR signaling pathway under ER stress. Increased expression of these ER stress markers was observed in the tubulointerstitial compartment of human kidneys with proteinuric kidney diseases such as diabetic nephropathy and human immunodeficiency virus-associated nephropathy (7,12).In a recent study (7), we found that increased expression of reticulon (RTN)1 was associated with the progression of CKD and inversely correlated with kidney function (as assessed by the estimated glomerular filatration rate) in patients with diabetic nephropathy (DN). RTN1 belongs to a family of RTN proteins (RTN1-RTN4), which were first described in neuroendocrine cells to localize primarily to the ER membrane as ER-shaping proteins (8, 25). RTN4, also named Nogo, has previously been the only well-characterized member in the RTN family that has been shown to induce apoptosis, inhibit neuronal regeneration, and regulate protein trafficking (1,8,17). Our results showed that of the three RTN1 isoforms (RTN1A, RT...