Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Kidney360. 2024 Sep 1;5(9):1394-1401. doi: 10.34067/KID.0000000000000531. Epub 2024 Aug 9.
Lupus nephritis (LN) is the most common major organ manifestation of the autoimmune disease SLE (lupus), with 10% of those afflicted progressing to ESKD. The kidney in LN is characterized by a significant immune infiltrate and proinflammatory cytokine milieu that affects intrinsic renal cells and is, in part, responsible for the tissue damage observed in LN. It is now increasingly appreciated that LN is not due to unidirectional immune cell activation with subsequent kidney damage. Rather, the kidney microenvironment influences the recruitment, survival, differentiation, and activation of immune cells, which, in turn, modify kidney cell function. This review covers how the biochemical environment of the kidney ( i.e ., low oxygen tension and hypertonicity) and unique kidney cell types affect the intrarenal immune cells in LN. The pathways used by intrinsic renal cells to interact with immune cells, such as antigen presentation and cytokine production, are discussed in detail. An understanding of these mechanisms can lead to the design of more kidney-targeted treatments and the avoidance of systemic immunosuppressive effects and may represent the next frontier of LN therapies.
狼疮性肾炎(LN)是自身免疫性疾病系统性红斑狼疮(狼疮)最常见的主要器官表现,其中 10%的患者进展为终末期肾病。LN 中的肾脏特征是存在大量免疫浸润和促炎细胞因子微环境,影响固有肾细胞,部分原因是导致 LN 中观察到的组织损伤。现在越来越多的人认识到,LN 不是由于免疫细胞单向激活,随后导致肾脏损伤。相反,肾脏微环境影响免疫细胞的募集、存活、分化和激活,而这些细胞反过来又改变肾脏细胞的功能。这篇综述涵盖了肾脏的生化环境(即低氧张力和高渗性)和独特的肾脏细胞类型如何影响 LN 中的肾内免疫细胞。详细讨论了固有肾细胞与免疫细胞相互作用的途径,如抗原呈递和细胞因子产生。对这些机制的理解可以导致更具针对性的肾脏治疗方法的设计,并避免全身免疫抑制作用,这可能代表 LN 治疗的下一个前沿领域。