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Methionine is converted to S-adenosylmethionine (SAM) by methionine adenosyltransferase (MAT), which then creates S-adenosylhomocysteine (SAH) via TSS.SAH is converted to homocysteine (HCY), a precursor of cysteine, by S-adenosylhomocysteine hydrolase (SAHH) (99, 100)

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While hypoperfusion likely plays a role, oxidative stress and subsequent renal tissue damage from reactive oxygen species occurs due to both ischemia-reperfusion injury and activation of inflammatory cascades when blood is exposed to the CPB circuit [37]