Cytokines, T cells and proliferative glomerulonephritis

SUMMARY: The glomerulus, by virtue of its functional role as a filter, is vulnerable to injury in the context of inflammatory responses, with the potential involvement of a number of different inflammatory processes. Recent work has provided insights into the role of T cells in proliferative glomerulonephritis, particularly in determining patterns of injury and outcomes in cresentic forms of glomerulonephritis. Experimental models have shown that in proliferative glomerulonephritis, cytokines play important roles both in determining T helper cell phenotype (particularly in the context of T helper cell 1 responses) and (from T cell themselves) in activating effectors of injury. Conversely, some cytokines regulate T cell responses to limit injury. There is an emerging role in other areas of the inflammatory response for cytokines traditionally thought to be involved predominantly in the injurious T cell response. These include regulatory T cells, the interaction between resident renal cells and leukocytes and the development of renal fibrosis. Cytokine‐based therapies are entering clinical practice in other diseases. However, a number of challenges and questions remain to be answered before translating basic understanding into clinical practice in immune glomerular injury.