IMMUNOLOGIC renal injury can be mediated by immune complexes or by free antibody that interacts with native or tissue-bound antigen.
RENAL DISEASE MEDIATED BY IMMUNE COMPLEXES
The most common mechanism of renal injury involves deposition of immune reactants in the kidney. Circulating immune complexes must have certain physical and biologic properties to be able to localize in tissues and cause injury. Complexes of large size, for example, those at equivalence, are poorly soluble and disposed of by cells of the mononuclear-phagocyte system. Complexes of very small size, formed in extreme antigen excess, are soluble and have limited nephrotoxicity because they do not fix complement. Complexes that are formed in slight antigen excess are both soluble and able to fix complement; such complexes may be nephrotoxic.Whenever appropriate antibodies interact with antigen, the complement system may be activated. Activation of the complement system can lead to alterations in vascular permeability (and
Mathews KP, Calvallo T. Immune Aspects of Renal Diseases. JAMA. 1982;248(20):2701–2703. doi:10.1001/jama.1982.03330200125023
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