The role of the immune system in kidney disease

• Published in: Clinical and experimental immunology Vol. 192; no. 2; pp. 142 - 150
• Main Authors: Tecklenborg, J., Clayton, D., Siebert, S., Coley, S. M.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.05.2018; John Wiley and Sons Inc
• Subjects: Autoantibodies; Autoimmune diseases; Autoimmunity; Collagen (type IV); Complement activation; Complex formation; Fibrosis; Homeostasis; immune homeostasis; Immune system; inflammation; kidney disease; Kidney diseases; Kidneys; Renal failure; Renal function; Review; kidney disease; fibrosis; immune homeostasis; inflammation
• ISSN: 0009-9104; 1365-2249
• DOI: 10.1111/cei.13119

Summary The immune system and the kidneys are closely linked. In health the kidneys contribute to immune homeostasis, while components of the immune system mediate many acute forms of renal disease and play a central role in progression of chronic kidney disease. A dysregulated immune system can have either direct or indirect renal effects. Direct immune‐mediated kidney diseases are usually a consequence of autoantibodies directed against a constituent renal antigen, such as collagen IV in anti‐glomerular basement membrane disease. Indirect immune‐mediated renal disease often follows systemic autoimmunity with immune complex formation, but can also be due to uncontrolled activation of the complement pathways. Although the range of mechanisms of immune dysregulation leading to renal disease is broad, the pathways leading to injury are similar. Loss of immune homeostasis in renal disease results in perpetual immune cell recruitment and worsening damage to the kidney. Uncoordinated attempts at tissue repair, after immune‐mediated disease or non‐immune mediated injury, result in fibrosis of structures important for renal function, leading eventually to kidney failure. As renal disease often manifests clinically only when substantial damage has already occurred, new diagnostic methods and indeed treatments must be identified to inhibit further progression and promote appropriate tissue repair. Studying cases in which immune homeostasis is re‐established may reveal new treatment possibilities. The role of the immune system in renal pathology