Immunology articles within Nature Reviews Nephrology

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  • Review Article |

    Renal disease is a frequent complication of HIV infection, and a spectrum of renal disorders has been described with diverse histopathologic forms. In this Review, Scott Cohen and colleagues outline the epidemiology of renal disease in HIV and how it has changed since the introduction of combined antiretroviral therapy. They discuss the clinical manifestations and mechanisms underlying renal disease development in patients with HIV, and the issues pertaining to diagnosis and therapeutics.

    • Ehsan Nobakht
    • , Scott D. Cohen
    •  & Paul L. Kimmel

  • Review Article |

    A relationship between IgA nephropathy (IgAN) and the mucosa has long been recognized with evidence from clinical observations and genetic studies suggesting that abnormalities in the IgA mucosal immune system could be a key element in the pathogenesis of IgAN. In this Review, Jürgen Floege and John Feehally describe current evidence that links the mucosa, in particular the gastrointestinal mucosa, and IgA produced in the bone marrow with IgAN.

    • Jürgen Floege
    •  & John Feehally

  • Year in Review |

    Numerous studies in 2015 focused on therapeutic immune modulation and immunosuppression. Trials of budenoside in patients with IgA nephropathy who are unresponsive to supportive therapy, and of low-dose IL-2 to enforce regulatory T-cell-mediated immunosuppression in autoimmune disease all produced promising results.

    • Hans-Joachim Anders

  • Review Article |

    Renal anaemia, resulting from impaired renal production of erythropoietin, is a common occurrence in patients with chronic kidney disease. Conventional erythropoiesis stimulating agents can be used to treat the condition, but small-molecule inhibitors of prolyl hydroxylase domain-containing (PHD) enzymes might provide a more efficient and tolerable approach to anaemia management. Here, Maxwell and Eckardt describe the rationale for targeting PHD enzymes to increase erythropoietin production. They also discuss other potential on-target consequences of HIF activation and possible off-target effects on enzymes that are structurally similar to PHD enzymes.

    • Patrick H. Maxwell
    •  & Kai-Uwe Eckardt

  • Review Article |

    In the past decade considerable advances have been made in understanding the physiology and pathophysiology of coagulation proteases, their regulators and receptors in renal disease. In this Review, Berend Isermann and colleagues discuss the haemostatic and non-haemostatic functions of coagulation regulators and receptors in the kidney, the roles of coagulation proteases in acute kidney injury, chronic kidney disease and renal transplantation, and the potential for translating these insights into targeted therapies.

    • Thati Madhusudhan
    • , Bryce A. Kerlin
    •  & Berend Isermann

  • Review Article |

    Pattern recognition receptors and danger-associated molecular patterns of the innate immune system contribute to the initiation of an inflammatory response in diabetes mellitus and diabetic nephropathy. In this Review, Jun Wada and Hirofumi Makino discuss how these components of the innate immune system can lead to insulin resistance, diabetes mellitus, and renal failure and describe signalling mediators and pathways that could be targeted for treatment.

    • Jun Wada
    •  & Hirofumi Makino

  • Review Article |

    Renal involvement in primary Sjögren syndrome (pSS) is a rare complication, but regular screening is required for early detection and prevention of progression to chronic kidney disease. In this Review, Hélène François and Xavier Mariette discuss the most frequent renal complications that can occur in pSS, namely tubulointerstitial nephritis and membranoproliferative glomerular nephritis. They outline the pathophysiology of these complications, the differential diagnoses, and current treatment options.

    • Hélène François
    •  & Xavier Mariette

  • Review Article |

    Acute kidney injury (AKI) is highly prevalent in patients admitted to the intensive care unit, and many of these patients also develop concomitant respiratory complications. In this Review, Faubel and Edelstein discuss the traditional and non-traditional complications of AKI, focusing in particular on the pathologic mechanisms that underlie respiratory complications and the mediators of AKI-induced pulmonary inflammation.

    • Sarah Faubel
    •  & Charles L. Edelstein

  • News & Views |

    Although the first 50 years of renal transplantation were marked by great advances in immunosuppressive therapies, the past decade has been marked by an unprecedented increase in technology. This progress has spurred investigators to challenge old paradigms and investigate how best to utilize these technologies to further improve patient care.

    • Bruce Kaplan

  • Review Article |

    The development of effective desensitization strategies has enabled ABO incompatible (ABOi) kidney transplantation to become an established treatment option for patients with end-stage renal disease. Here, the authors review the mechanisms that underlie acceptance and rejection of ABOi grafts, recipient desensitization strategies, patient outcomes and novel treatment strategies that might promote graft acceptance and enable minimization of immunosuppression.

    • Georg A. Böhmig
    • , Andreas M. Farkas
    •  & Thomas Wekerle

  • Review Article |

    Urinary tract infections (UTIs), including pyelonephritis, are among the most common and serious infections encountered by nephrologists. Emerging evidence suggests a fundamental role for the innate immune system in protecting the urothelium from bacterial challenge. This Review provides an overview of UTI pathogenesis in the upper and lower urinary tract. The authors describe the role of intercalated cells and the innate immune response in preventing UTI, focusing on the role of antimicrobial peptides in maintaining urinary tract sterility.

    • Brian Becknell
    • , Andrew Schwaderer
    •  & John David Spencer

  • Review Article |

    IgG4-related disease can affect any organ system, including the kidney. Renal involvement is an indication for prompt treatment, owing to an increased risk of chronic kidney disease. In this Review, Frank Cortazar and John Stone provide an overview of systemic IgG4-related disease before describing in detail the renal manifestations of IgG4-related tubulointerstitial nephritis and membranous glomerulonephropathy secondary to IgG4-related disease. They consider the pathophysiology, as well as current and future treatment options.

    • Frank B. Cortazar
    •  & John H. Stone

  • Review Article |

    Anaemia is a clinical hallmark of advanced kidney disease, characterized by insufficient erythropoiesis due to inadequate erythropoietin production in the kidney, inflammation and iron deficiency. Here, Mark Koury and Volker Haase discuss the hypoxic regulation of erythropoiesis and renal erythropoietin production, providing insight into the inter-relationships between erythropoietin synthesis, erythrocyte production, iron metabolism and inflammatory mediators. They also describe current clinical experience with pharmacologic activators of hypoxia-inducible factor signalling as an emerging approach to the treatment of renal anaemia.

    • Mark J. Koury
    •  & Volker H. Haase

  • Review Article |

    Resident microorganisms in the human body vastly outnumber host cells and have an important role in human physiology. In this Review, Bromberg and colleagues discuss the basic principles that guide analyses of the microbiota, including the challenges of measuring and quantifying microbiota. They also discuss the influence of the microbiota on the immune system and the implications of these effects on organ failure and transplantation.

    • Jonathan S. Bromberg
    • , W. Florian Fricke
    •  & Emmanuel F. Mongodin

  • Review Article |

    Post-transplantation diabetes mellitus (PTDM) is a frequent complication among renal transplant recipients, and is associated with cardiovascular disease and reduced lifespan. In this Review, Jenssen and Hartmann discuss the diagnostic criteria for PTDM and evaluate available and emerging treatment options, highlighting the considerations that should be made when selecting an appropriate therapeutic regimen.

    • Trond Jenssen
    •  & Anders Hartmann

  • Review Article |

    Systemic lupus erythematosus (SLE) is a complex, autoimmune disorder that can have debilitating effects on various organs, including the kidneys. Here, Mohan and Putterman discuss the genetic candidates associated with SLE and lupus nephritis, and highlight possible molecular mechanisms that might contribute to disease pathology. Given the highly variable clinical presentation of SLE, the authors propose that greater understanding of the molecular basis of SLE and lupus nephritis is required to facilitate the generation of specific tailored therapies in the future.

    • Chandra Mohan
    •  & Chaim Putterman

  • News & Views |

    Statins reduce the risk of atherosclerotic vascular disease in healthy individuals and those with chronic kidney disease (CKD); however, clinical trials have suggested a minimal effect of statins on CKD progression. The PLANET trials compared the renal effects of rosuvastatin and atorvastatin, but the findings leave many questions unanswered.

    • Richard Haynes
    •  & Christoph Wanner

  • News & Views |

    Whether anticoagulation with warfarin is safe and reduces risk of stroke in patients with atrial fibrillation and chronic kidney disease is unclear. A recent observational study shows a net clinical benefit of warfarin—without increased risk of bleeding—in this population, including in patients on dialysis.

    • Arman Qamar
    •  & Deepak L. Bhatt

  • Review Article |

    Acute kidney injury (AKI) is associated with high levels of mortality and an increased risk of progressive chronic kidney disease. Here, David Ferenbach and Joseph Bonventre describe the mechanisms involved in the initiation and propagation of AKI. They discuss the prototypic mechanisms employed by the damaged kidney to repair, and how the adaptive processes of repair can become maladaptive, leading to the development of progressive fibrotic kidney disease and a state that can be considered accelerated kidney ageing.

    • David A. Ferenbach
    •  & Joseph V. Bonventre

  • Review Article |

    Hepatitis C virus (HCV) infection imposes a substantial economic, clinical, and societal burden worldwide. In this Review, Morales and Fabrizi compare the treatment options that are available to patients with HCV infection, before and after renal transplantation. The development of novel therapeutic strategies and the clinical complications associated with HCV infection are discussed. The authors conclude with an assessment of the safe use of organs donated from individuals with active HCV infection.

    • Jose M. Morales
    •  & Fabrizio Fabrizi

  • News & Views |

    Maintenance therapy for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) should reduce rates of relapse with minimal toxicity. The MAINRITSAN trial—the first randomized controlled trial to compare the efficacies of rituximab and azathioprine in AAV remission maintenance—has demonstrated a superior outcome using rituximab. These data have important implications for the management of AAV.

    • Anisha Tanna
    •  & Charles Pusey

  • Year in Review |

    Several studies published in 2014 might facilitate improvements in the treatment and long-term care of renal transplant recipients. The potential risks of living kidney donation, the efficacy and safety of alemtuzumab-based induction therapy, and the treatment of chronic hepatitis E virus infection have been addressed.

    • Dennis A. Hesselink
    •  & Willem Weimar

  • Review Article |

    Insights into the pathogenesis of membranoproliferative glomerulonephritis (MPGN) have transformed our understanding of the processes that can lead to the morphological appearance of this pattern of injury. It is now recognized that many cases of MPGN are characterized by the deposition of the complement component C3 in glomeruli without immunoglobulin deposition; this group of diseases is now referred to as C3 glomerulopathies. In this Review, Cook and Pickering discuss the morphological features of MPGN and their different associated pathological processes, in addition to the histological features of C3 glomerulopathies.

    • H. Terence Cook
    •  & Matthew C. Pickering

  • News & Views |

    A new study has reported a molecular signature of T-cell-mediated rejection in human kidney transplant biopsy samples that is enriched for effector T cells, interferon-γ and macrophages. Inhibitors of T-cell activation, such as CTLA4 and PDL1, were also prominent, raising the possibility that these immunological constrains could be harnessed by therapies for treating rejection.

    • Anita S. Chong
    •  & David L. Perkins

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