Neural pathways regulate immunity and inflammation via the inflammatory reflex and specific molecular targets can be modulated by stimulating neurons. Neuroimmunomodulation by nonpharmacological methods is emerging as a novel therapeutic strategy for inflammatory diseases, including kidney diseases and hypertension. Electrical stimulation of vagus neurons or treatment with pulsed ultrasound activates the cholinergic anti-inflammatory pathway (CAP) and protects mice from acute kidney injury (AKI). Direct innervation of the kidney, by afferent and efferent neurons, might have a role in modulating and responding to inflammation in various diseases, either locally or by providing feedback to regions of the central nervous system that are important in the inflammatory reflex pathway. Increased sympathetic drive to the kidney has a role in the pathogenesis of hypertension, and selective modulation of neuroimmune interactions in the kidney could potentially be more effective for lowering blood pressure and treating inflammatory kidney diseases than renal denervation. Use of optogenetic tools for selective stimulation of specific neurons has enabled the identification of neural circuits in the brain that modulate kidney function via activation of the CAP. In this Review we discuss evidence for a role of neural circuits in the control of renal inflammation as well as the therapeutic potential of targeting these circuits in the settings of AKI, kidney fibrosis and hypertension.

神经通路通过炎症反射调节免疫和炎症，并且可以通过刺激神经元来调节特定的分子靶标。通过非药物方法进行神经免疫调节正在成为治疗炎症性疾病（包括肾脏疾病和高血压）的一种新策略。迷走神经元的电刺激或脉冲超声治疗可激活胆碱能抗炎通路（CAP）并保护小鼠免受急性肾损伤（AKI）。传入和传出神经元对肾脏的直接神经支配可能在调节和响应各种疾病中的炎症方面发挥作用，无论是局部的还是通过向炎症反射途径中重要的中枢神经系统区域提供反馈。肾脏交感神经驱动的增加在高血压的发病机制中发挥作用，选择性调节肾脏中的神经免疫相互作用可能比肾脏去神经术更有效地降低血压和治疗炎症性肾脏疾病。使用光遗传学工具选择性刺激特定神经元，能够识别大脑中通过激活 CAP 调节肾功能的神经回路。在这篇综述中，我们讨论了神经回路在控制肾脏炎症中的作用的证据，以及针对 AKI、肾纤维化和高血压背景下这些回路的治疗潜力。