Linking PFOS exposure to chronic kidney disease: A multimodal study integrating epidemiology, network toxicology, and experimental validation

Perfluorooctane sulfonate (PFOS), a widely used persistent organic pollutant, has been implicated in multiple toxicities. However, its nephrotoxic mechanisms remain unclear. Chronic kidney disease (CKD) is a growing global health concern. We adopted a multidisciplinary approach combining epidemiological analysis, network toxicology, molecular docking, and animal experiments to investigate PFOS-induced kidney injury using CKD as a model. NHANES data (n = 9119) were analyzed to examine the association between serum PFOS levels and CKD prevalence. Network toxicology identified PFOS-related target genes, which were further refined through protein-protein interaction (PPI) analysis and validated using the GSE32591 dataset. A diagnostic model was constructed, and molecular docking and in vivo studies were performed to verify gene-compound interactions and biological effects. Coremine Medical was used to identify traditional Chinese medicine (TCM) candidates targeting key genes. Serum PFOS levels were significantly associated with CKD, showing a U-shaped dose-response. Four hub genes-ALB, PTGS2, AKT1, and IGF1-were identified and used to develop a diagnostic model with excellent accuracy (AUC = 0.96). Molecular docking confirmed stable PFOS-protein interactions. PFOS exposure in mice led to dose-dependent renal tubular injury, elevated NGAL and KIM-1 levels, and PI3K-AKT pathway activation. Astragalus membranaceus, identified through TCM screening, exhibited strong binding to the target proteins and may have therapeutic potential. This study reveals key molecular targets and pathways involved in PFOS-induced nephrotoxicity and proposes a TCM-based therapeutic strategy. Our findings offer new perspectives for risk assessment and intervention in PFOS-related kidney disease.