The increasing number of clinical conditions that involve a pathological contribution from the complement system — many of which affect the kidneys — has spurred a regained interest in therapeutic options to modulate this host defence pathway. Molecular insight, technological advances, and the first decade of clinical experience with the complement-specific drug eculizumab, have contributed to a growing confidence in therapeutic complement inhibition. More than 20 candidate drugs that target various stages of the complement cascade are currently being evaluated in clinical trials, and additional agents are in preclinical development. Such diversity is clearly needed in view of the complex and distinct involvement of complement in a wide range of clinical conditions, including rare kidney disorders, transplant rejection and haemodialysis-induced inflammation. The existing drugs cannot be applied to all complement-driven diseases, and each indication has to be assessed individually. Alongside considerations concerning optimal points of intervention and economic factors, patient stratification will become essential to identify the best complement-specific therapy for each individual patient. This Review provides an overview of the therapeutic concepts, targets and candidate drugs, summarizes insights from clinical trials, and reflects on existing challenges for the development of complement therapeutics for kidney diseases and beyond.

越来越多的临床病症涉及补体系统的病理作用（其中许多影响肾脏），这激起了人们对调节宿主防御途径的治疗方案重新产生兴趣。分子洞察力、技术进步以及补体特异性药物依库珠单抗前十年的临床经验，使得人们对补体抑制治疗的信心不断增强。目前正在临床试验中评估 20 多种针对补体级联各个阶段的候选药物，还有其他药物正在进行临床前开发。鉴于补体在广泛的临床病症中复杂而独特的参与，包括罕见的肾脏疾病、移植排斥和血液透析引起的炎症，显然需要这种多样性。现有的药物不能适用于所有补体驱动的疾病，并且每个适应症都必须单独评估。除了考虑最佳干预点和经济因素之外，患者分层对于为每个患者确定最佳的补体特异性治疗也至关重要。本综述概述了治疗概念、靶点和候选药物，总结了临床试验的见解，并反思了肾脏疾病及其他疾病的补体疗法开发中现有的挑战。