The kidney, a victim and culprit of autoimmune and alloimmune responses

The Working Group of the European Renal Association-European Nephrology and Dialysis Association (ERA-EDTA) dedicated to immune system involvement in renal disease (Immunonephrology Working Group) was established in 2009 to facilitate exchanges of ideas on basic science research and new treatment protocols among European nephrologists. A section of the ERA-EDTA website describes activities and is open for new applications and proposals. In 2010, the first meeting of this Working Group focused on aspects of immune-mediated renal damage shared by kidney during glomerulonephritides or after kidney transplantation. From the large series of data reported, a previously disregarded presence of pathogenetic and therapeutic aspects common to glomerular diseases and transplanted kidneys was highlighted. Although the antigens involved in transplant rejection and in glomerulonephritis are different, a number of factors involved in the effector response are similar, mainly those based on the interaction between innate and adaptive immune mechanisms and on the strict cooperation between T and B cells. Moreover, the common target for the allo- and autoimmune attacks is represented by the endothelial cells, of which the kidney is particularly rich. These similarities may explain why immunomodulating treatments used in alloimmunity may also be useful in autoimmune diseases and vice versa. Considering renal damage from a holistic point of view may favour exchange of news for two formerly considered non-communicant areas, i.e. glomerular disease and renal transplantation nephrology sections.