Gluhovschi Cristina, Gadalean Florica, Velciov Silvia, Nistor Mirabela, Petrica Ligia
Division of Nephrology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania.
Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania.
Biomedicines. 2023 Nov 6;11(11):2978. doi: 10.3390/biomedicines11112978.
Immune mechanisms play an important role in the pathogenesis of glomerulonephritis (GN), with autoimmunity being the main underlying pathogenetic process of both primary and secondary GN. We present three autoimmune diseases mediated by different autoimmune mechanisms: glomerulonephritis in vasculitis mediated by anti-neutrophil cytoplasmic antibodies (ANCAs), glomerulonephritis mediated by anti-glomerular basement membrane antibodies (anti-GBM antibodies), and immune complex-mediated glomerulonephritis. Some of these diseases represent a common clinical and histopathologic scenario, namely rapidly progressive crescentic glomerulonephritis. This is a severe illness requiring complex therapy, with the main role being played by therapy aimed at targeting immune mechanisms. In the absence of immune therapy, the crescents, the characteristic histopathologic lesions of this common presentation, progress toward fibrosis, which is accompanied by end-stage renal disease (ESRD). The fact that three diseases mediated by different immunopathologic mechanisms have a common clinical and histopathologic picture reveals the complexity of the relationship between immunopathologic mechanisms and their clinical expression. Whereas most glomerular diseases progress by a slow process of sclerosis and fibrosis, the glomerular diseases accompanied by glomerular crescent formation can progress, if untreated, in a couple of months into whole-nephron glomerulosclerosis and fibrosis. The outcome of different immune processes in a common clinical and histopathologic phenotype reveals the complexity of the relationship of the kidney with the immune system. The aim of this review is to present different immune processes that lead to a common clinical and histopathologic phenotype, such as rapidly progressive crescentic glomerulonephritis.
免疫机制在肾小球肾炎(GN)的发病机制中起重要作用,自身免疫是原发性和继发性GN的主要潜在发病过程。我们介绍三种由不同自身免疫机制介导的自身免疫性疾病:抗中性粒细胞胞浆抗体(ANCA)介导的血管炎中的肾小球肾炎、抗肾小球基底膜抗体(抗GBM抗体)介导的肾小球肾炎以及免疫复合物介导的肾小球肾炎。其中一些疾病表现出常见的临床和组织病理学情况,即快速进行性新月体性肾小球肾炎。这是一种需要复杂治疗的严重疾病,主要治疗作用由针对免疫机制的疗法发挥。在没有免疫治疗的情况下,新月体(这种常见表现的特征性组织病理学病变)会进展为纤维化,并伴有终末期肾病(ESRD)。由不同免疫病理机制介导的三种疾病具有共同的临床和组织病理学表现,这一事实揭示了免疫病理机制与其临床表达之间关系的复杂性。虽然大多数肾小球疾病通过缓慢的硬化和纤维化过程进展,但伴有肾小球新月体形成的肾小球疾病如果不治疗,可能在几个月内进展为全肾单位肾小球硬化和纤维化。在共同的临床和组织病理学表型中不同免疫过程的结果揭示了肾脏与免疫系统关系的复杂性。本综述的目的是介绍导致共同临床和组织病理学表型(如快速进行性新月体性肾小球肾炎)的不同免疫过程。