Chronic diabetes is associated with metabolic and haemodynamic stresses which can facilitate modifications to DNA, proteins and lipids, induce cellular dysfunction and damage, and stimulate inflammatory and fibrotic responses which lead to various types of renal injury. Approximately 30–40% of patients with diabetes develop nephropathy and this renal injury normally progresses in about a third of patients. Due to the growing incidence of diabetes, diabetic nephropathy is now the main cause of end-stage renal disease (ESRD) worldwide. Accumulating evidence from experimental and clinical studies has demonstrated that renal inflammation plays a critical role in determining whether renal injury progresses during diabetes. However, the immune response associated with diabetic nephropathy is considerably different to that seen in autoimmune kidney diseases or in acute kidney injury arising from episodes of ischaemia or infection. This review evaluates the role of the immune system in the development of diabetic nephropathy, including the specific contributions of leucocyte subsets (macrophages, neutrophils, mast cells, T and B lymphocytes), danger-associated molecular patterns (DAMPs), inflammasomes, immunoglobulin and complement. It also examines factors which may influence the development of the immune response, including genetic factors and exposure to other kidney insults. In addition, this review discusses therapies which are currently under development for targeting the immune system in diabetic nephropathy and indicates those which have proceeded into clinical trials.
Skip Nav Destination
Article navigation
Review Article|
July 31 2017
Diabetic nephropathy – is this an immune disorder?
Greg H. Tesch
1Department of Nephrology, Monash Health, Clayton, Victoria, Australia
2Monash University Department of Medicine, Monash Health, Clayton, Victoria, Australia
3Centre for Inflammatory Diseases, Monash Health, Clayton, Victoria, Australia
Correspondence: Greg Tesch ([email protected])
Search for other works by this author on:
Publisher: Portland Press Ltd
Received:
June 02 2017
Revision Received:
July 04 2017
Accepted:
July 10 2017
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society
2017
Clin Sci (Lond) (2017) 131 (16): 2183–2199.
Article history
Received:
June 02 2017
Revision Received:
July 04 2017
Accepted:
July 10 2017
Citation
Greg H. Tesch; Diabetic nephropathy – is this an immune disorder?. Clin Sci (Lond) 15 August 2017; 131 (16): 2183–2199. doi: https://doi.org/10.1042/CS20160636
Download citation file:
Sign in
Don't already have an account? Register
Sign in to your personal account
You could not be signed in. Please check your email address / username and password and try again.
Could not validate captcha. Please try again.