Immunology articles within Nature Reviews Nephrology

Featured

  • Review Article |

    Chronic kidney disease accelerates atherosclerosis via augmentation of inflammation, perturbation of lipid metabolism, and other mechanisms. Here, the authors describe the role of the immune system in the initiation and progression of atherosclerosis and discuss potential opportunities for therapy.

    • Anton Gisterå
    •  & Göran K. Hansson

  • Review Article |

    Accumulating evidence indicates that activation of the complement system is crucial for the development of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This Review provides an overview of the role of complement activation in AAV, and discusses how targeting this pathway can provide opportunities for treatment.

    • Min Chen
    • , David R. W. Jayne
    •  & Ming-Hui Zhao

  • Review Article |

    T cells are critical drivers of autoimmunity and related organ damage, by supporting B-cell differentiation and antibody production or by directly promoting inflammation and cytotoxicity. This Review discusses the immune features of autoimmune nephropathies, with a focus on systemic lupus erythematosus and the role of T cells.

    • Abel Suárez-Fueyo
    • , Sean J. Bradley
    •  & George C. Tsokos

  • News & Views |

    Elimination of donor-specific antibodies against HLA has been used to enable transplantation of HLA-incompatible kidneys from living donors. In contrast to two previous US studies, a UK study now reports that desensitization does not offer a survival benefit over remaining on the waitlist for a compatible organ.

    • Caner Süsal
    •  & Gerhard Opelz

  • Review Article |

    An increasing body of evidence points toward a role for the complement system in the pathogenesis of diabetic nephropathy. Here, Allan Flyvbjerg describes the underlying experimental and clinical evidence and discusses how the association between complement activation and diabetic nephropathy might facilitate the identification of new biomarkers of disease progression and targets for therapeutic intervention.

    • Allan Flyvbjerg

  • Review Article |

    Haemodialysis is associated with a high risk of cardiovascular events. Here, the authors discuss the mechanisms by which biomaterial-induced activation of the complement, contact and coagulation systems might contribute to the generation of arteriosclerosis and cardiovascular disease in patients on haemodialysis.

    • Kristina N. Ekdahl
    • , Inga Soveri
    •  & Bo Nilsson

  • Review Article |

    Heparanase is an endoglycosidase that regulates numerous cell functions and is able to degrade the extracellular matrix component heparan sulfate, which has a key role in maintaining the integrity of the glomerular filtration barrier. In this Review, Rabelink and colleagues describe the biological regulation and functions of heparanase, including the role of this enzyme in the development of kidney disease.

    • Ton J. Rabelink
    • , Bernard M. van den Berg
    •  & Johan van der Vlag

  • Year in Review |

    Approaches to effectively prevent and manage organ dysfunction in critically ill patients remain elusive. Key studies in 2016 highlighted the challenges in finding effective treatments for renal failure in sepsis and assessed the optimal timing of renal replacement therapy initiation in critically ill patients with acute kidney injury.

    • Ravindra L. Mehta

  • Year in Review |

    Kidney transplantation was the focus of numerous publications in 2016. Key studies demonstrated a survival advantage of HLA-incompatible kidney transplantation and suggested that novel approaches such as co-stimulation blockade using belatacept and treatment of antibody-mediated rejection using a C1 esterase inhibitor might prove to be future game changers.

    • Paolo Malvezzi
    •  & Lionel Rostaing

  • Review Article |

    Decreasing susceptibility to tissue damage — a protective strategy known as tolerance — might be as important as infection resistance in determining outcomes in sepsis. Here, the authors discuss tolerance mechanisms that act in the kidney during sepsis, with a focus on the role of metabolic reprogramming.

    • Hernando Gómez
    • , John A. Kellum
    •  & Claudio Ronco

  • News & Views |

    As IgA nephropathy (IgAN) is considered to result in part from autoimmune processes, B-cell depletion using rituximab might be a plausible therapy. However, a small randomized, controlled trial in patients at risk of progressive IgAN reports that this therapy failed to reduce proteinuria over 1 year and was associated with more adverse events per patient.

    • Jürgen Floege

  • Review Article |

    The mTOR pathway has a role in the development of renal disease, kidney transplant rejection and malignancies. Here, the authors discuss the mechanisms by which mTOR complexes drive the pathogenesis of these diseases as well as the therapeutic potential of mTOR inhibitors.

    • Daniel Fantus
    • , Natasha M. Rogers
    •  & Angus W. Thomson

  • Review Article |

    Autoantibodies against complement factor H (FH), the main plasma regulatory protein of the alternative pathway of the complement system, are associated with atypical haemolytic uraemic syndrome and C3 glomerulopathy. Here, Arvind Bagga and colleagues describe the prevalence, mechanisms, features, therapies and outcomes of kidney diseases mediated by anti-FH antibodies, and propose an approach to evaluate and manage these diseases.

    • Marie-Agnes Dragon Durey
    • , Aditi Sinha
    •  & Arvind Bagga

  • Review Article |

    Antibodies directed against non-HLA antigens such as angiotensin type 1 receptor, perlecan and collagen have been implicated in antibody-mediated rejection. Here, Elaine Reed and Qiuheng Zhang discuss the clinical relevance and pathogenesis of these non-HLA antibodies in renal, heart and lung transplantation.

    • Qiuheng Zhang
    •  & Elaine F. Reed

  • Review Article |

    Neutrophils are crucial regulators of the innate immune response and act as a first line of defence against invading microorganisms. To target microorganisms, neutrophils release extracellular structures called neutrophil extracellular traps (NETs), which externalize key autoantigens. In this Review, Gupta and Kaplan explore the contribution of neutrophils and NETs to the pathophysiology of systemic autoimmune disorders that can affect the kidneys, and discuss neutrophils as novel therapeutic targets for these diseases.

    • Sarthak Gupta
    •  & Mariana J. Kaplan

  • Review Article |

    The functions of the complement system are diverse and extend beyond its role in host defence; complement activation is now known to contribute to numerous immunological, inflammatory and age-related conditions, including kidney disorders. Here, John Lambris and colleagues discuss the key activating, regulatory, and effector mechanisms of the complement system. They highlight important crosstalk connections with other regulatory systems, and, with a focus on kidney disease and transplantation, describe the involvement of complement in clinical conditions as well as promising therapeutic approaches.

    • Daniel Ricklin
    • , Edimara S. Reis
    •  & John D. Lambris

  • News & Views |

    The heterogeneity of pathomechanisms leading to systemic lupus erythematosus (SLE) might contribute to between-patient variations in treatment response. A new, longitudinal transcriptome analysis has identified molecularly distinct subgroups of SLE that correlate with disease activity; use of such disease classifiers might facilitate the development of stratified treatment recommendations.

    • Hans-Joachim Anders
    •  & Matthias Kretzler

  • Review Article |

    Transforming growth factor-β (TGF-β) is a key driver of fibrosis in chronic kidney disease, acting via canonical and non-canonical signalling pathways to activate myofibroblasts and induce the production of extracellular matrix. This Review describes the mechanisms by which TGF-β promotes renal fibrosis, the pathways that modulate TGF-β signalling, and new therapeutic opportunities for the inhibition of TGF-β-driven renal fibrosis

    • Xiao-ming Meng
    • , David J. Nikolic-Paterson
    •  & Hui Yao Lan

  • News & Views |

    A single-centre study found that desensitization therapy permits a good success rate of kidney transplantation with an incompatible living donor. Data from 22 US centres now suggest that this technique could be employed across multiple hospitals to prolong the lives of sensitized transplant recipients.

    • J. Michael Cecka

  • Review Article |

    Graft necrosis resulting from ischaemia–reperfusion injury leads to the release of endogenous molecules — damage-associated molecular patterns (DAMPs) — which trigger a sterile inflammatory reaction. The resulting immune response can impair transplant tolerance or result in acute or chronic graft rejection. In this Review, Braza et al. discuss the nature of DAMPs and their downstream signalling pathways, with a focus on Toll-like receptors. They outline various strategies to inhibit DAMP-induced inflammation with the aim of improving the outcomes of solid organ transplantation, and discuss the challenge of inhibiting the innate immune response within the graft without compromising the patient's response to pathogens.

    • Faouzi Braza
    • , Sophie Brouard
    •  & Daniel R. Goldstein

  • Review Article |

    Biological therapeutics that target autoimmune responses have markedly improved the treatment of numerous chronic diseases. In this Review, Stephen Holdsworth and colleagues discuss the opportunities for biologic intervention in autoimmune renal disorders. They outline the key targets that are known to contribute to an injurious inflammatory response, and the biologics that are already available to modulate them.

    • Stephen R. Holdsworth
    • , Poh-Yi Gan
    •  & A. Richard Kitching

  • Review Article |

    Autoantibodies are produced by plasma cells and contribute to the pathogenesis of many diseases, including systemic or organ-specific autoimmune diseases that involve the kidneys. In contrast to short-lived plasma cells, long-lived plasma cells reside in survival niches in the bone marrow and inflamed tissue, and provide the basis of humoral memory and refractory autoimmune disease activity. Here, the authors discuss the generation of plasma cells, their role in autoimmune disease, and current and future strategies for the depletion of autoreactive plasma cells, including novel approaches that target humoral memory.

    • Falk Hiepe
    •  & Andreas Radbruch

  • Review Article |

    Memory T cells and their ability to generate an anamnestic response are vital for protective immunity, but have a potentially detrimental impact on allograft survival. Here, Allan Kirk and colleagues discuss the generation of memory T cells, their role in allograft rejection and therapeutic strategies that target allospecific memory T-cell responses and might improve outcomes in organ transplantation.

    • Jaclyn R. Espinosa
    • , Kannan P. Samy
    •  & Allan D. Kirk

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