Kidney immunology from pathophysiology to clinical translation

Kidney diseases are widespread and represent a considerable medical, social and economic burden. However, there has been marked progress in understanding the immunological aspects of kidney disease. This includes the identification of distinct intrarenal immunological niches and characterization of kidney disease endotypes according to the underlying molecular immunopathology, as well as a better understanding of the pathological roles for T cells, mononuclear phagocytes and B cells and the renal elements they target. These insights have improved the diagnosis of kidney disease. Here, we discuss new developments in our understanding of kidney immunology, focusing on immune mechanisms of disease and their translational implications for the diagnosis and treatment of kidney disease. We also describe the immune-mediated crosstalk between the kidney and other organs that influences kidney disease and extrarenal inflammation. Kidney diseases affect millions globally. Advances in understanding immunological mechanisms and disease endotypes have enhanced diagnostic accuracy and treatment strategies. Here, the authors review our current understanding of immune mechanisms of kidney disease and highlight the interplay between renal and systemic immunity.