期刊
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
卷 17, 期 2, 页码 323-331出版社
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.04120321
关键词
chronic kidney disease; macrophages; chronic inflammation; fibrosis
资金
- Government of Canada Canadian Institutes of Health Research [201911FBD-433120-DRACEDA-251523]
- Physicians' Services Incorporated Foundation [RT8-2021]
Kidney homeostasis is reliant on the correct functioning of myeloid cells, which form a surveillance network in the kidney and play a crucial role in responding to organ threats. Dysregulation of these cells can lead to structural damage and fibrosis in the kidney, contributing to progressive decline in CKD. Therapies targeting myeloid cells and inflammation show promise in treating kidney disorders, with potential for expanding therapeutic indications as understanding of the myeloid-kidney interface evolves.
Kidney homeostasis is highly dependent upon the correct functioning of myeloid cells. These cells form a distributed surveillance network throughout the kidney, where they play an integral role in the response to organ threat. Dysregulation of resident proinflammatory and profibrotic macrophages leads to kidney structural damage and scarring after kidney injury. Fibrosis throughout the kidney parenchyma contributes to the progressive functional decline observed in CKD, independent of the etiology. Circulating myeloid cells bearing intrinsic defects also affect the kidney substructures, such as neutrophils activated by autoantibodies that cause GN in ANCA-associated vasculitis. The kidney can also be affected by disorders of myelopoiesis, including myeloid leukemias (acute and chronic myeloid leukemias) and myelodysplastic syndromes. Clonal hematopoiesis of indeterminate potential is a common, newly recognized premalignant clinical entity characterized by clonal expansion of hyperinflammatory myeloid lineage cells that may have significant kidney sequelae. A number of existing therapies in CKD target myeloid cells and inflammation, including glucocorticoid receptor agonists and mineralocorticoid receptor antagonists. The therapeutic indications for these and other myeloid cell-targeted treatments is poised to expand as our understanding of the myeloid-kidney interface evolves.
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