Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi 60069, Taiwan.
Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan.
Int J Mol Sci. 2022 Mar 24;23(7):3525. doi: 10.3390/ijms23073525.
Treatment for glomerular diseases has been extrapolated from the experience of other autoimmune disorders while the underlying pathogenic mechanisms were still not well understood. As the classification of glomerular diseases was based on patterns of juries instead of mechanisms, treatments were typically the art of try and error. With the advancement of molecular biology, the role of the immune agent in glomerular diseases is becoming more evident. The four-hit theory based on the discovery of gd-IgA1 gives a more transparent outline of the pathogenesis of IgA nephropathy (IgAN), and dysregulation of Treg plays a crucial role in the pathogenesis of minimal change disease (MCD). An epoch-making breakthrough is the discovery of PLA2R antibodies in the primary membranous nephropathy (pMN). This is the first biomarker applied for precision medicine in kidney disease. Understanding the immune system's role in glomerular diseases allows the use of various immunosuppressants or other novel treatments, such as complement inhibitors, to treat glomerular diseases more reasonable. In this era of advocating personalized medicine, it is inevitable to develop precision medicine with mechanism-based novel biomarkers and novel therapies in kidney disease.
肾小球疾病的治疗方法是从其他自身免疫性疾病的经验中推断出来的，而潜在的发病机制仍未得到很好的理解。由于肾小球疾病的分类是基于损伤模式而不是发病机制，因此治疗方法通常是试错的艺术。随着分子生物学的进步，免疫因子在肾小球疾病中的作用变得更加明显。基于 gd-IgA1 发现的四击理论为 IgA 肾病（IgAN）的发病机制提供了更透明的概述，而 Treg 的失调在微小病变性疾病（MCD）的发病机制中起着关键作用。一个划时代的突破是在原发性膜性肾病（pMN）中发现 PLA2R 抗体。这是第一个应用于肾脏疾病精准医学的生物标志物。了解免疫系统在肾小球疾病中的作用，可以更合理地使用各种免疫抑制剂或其他新型治疗方法，如补体抑制剂来治疗肾小球疾病。在倡导个性化医疗的时代，开发基于机制的新型生物标志物和新型疗法的精准医学是不可避免的。
