Schematic summary of the nAChRα1-calpain pathways involved in hypercholesterolemic CKD. The muscle-type nicotinic receptor (nAChRα1) has two known endogenous ligands: the uPA and acetylcholine. On ligation the receptor transforms into a calcium channel, which subsequently activates the intracellular calcium-dependent cysteine protease calpain-1. The activated calpain-1 promotes cell motility, perhaps by cleaving cytoskeleton–integrin linking proteins such as talin and liberating cell surface integrins (eg, CD11b/CD18). Calpain-1 hyperactivity significantly accelerates renal macrophage recruitment in the mouse model of hypercholesterolemic CKD. The persistently accumulated renal macrophages, through autocrine or interactions with kidney-resident cells (paracrine), produce various destructive molecules such as chemokines (eg, MCP-1 and OPN), cytokines (eg, TGF-β), and metalloproteinases (eg, MMP-2 and MMP-9). These molecules further enhance renal inflammation, degrade the collagen components of GBM/TBM, and promote the matrix-producing myofibroblasts by transforming mesangial cells and pericytes, or by activating interstitial fibroblasts. The nAChRα1-regulated calpain-1 activity may also be involved in the lipid-uptake process by macrophages and kidney-resident cells. These destructive events ultimately lead to significant clinical proteinuria and kidney function loss. MCP-1, macrophage chemoattractant protein-1; OPN, osteopontin; TGF-β, transforming growth factor-β; MMP, metalloproteinase; SCr, serum creatinine; BUN, blood urea nitrogen; GBM/TBM, glomerular and tubular basement membranes.