ATP and its ultimate degradation product adenosine are potent extracellular signalling molecules that elicit a variety of pathophysiological functions in the kidney through the activation of P2 and P1 purinergic receptors, respectively. Extracellular purines can modulate immune responses, balancing inflammatory processes and immunosuppression; indeed, alterations in extracellular nucleotide and adenosine signalling determine outcomes of inflammation and healing processes. The functional activities of ectonucleotidases such as CD39 and CD73, which hydrolyse pro-inflammatory ATP to generate immunosuppressive adenosine, are therefore pivotal in acute inflammation. Protracted inflammation may result in aberrant adenosinergic signalling, which serves to sustain inflammasome activation and worsen fibrotic reactions. Alterations in the expression of ectonucleotidases on various immune cells, such as regulatory T cells and macrophages, as well as components of the renal vasculature, control purinergic receptor-mediated effects on target tissues within the kidney. The role of CD39 as a rheostat that can have an impact on purinergic signalling in both acute and chronic inflammation is increasingly supported by the literature, as detailed in this Review. Better understanding of these purinergic processes and development of novel drugs targeting these pathways could lead to effective therapies for the management of acute and chronic kidney disease.

ATP及其最终降解产物腺苷是有效的细胞外信号分子，它们分别通过激活P2和P1嘌呤能受体而在肾脏中引发多种病理生理功能。细胞外嘌呤可以调节免疫反应，平衡炎症过程和免疫抑制。实际上，细胞外核苷酸和腺苷信号传导的改变决定了炎症和愈合过程的结果。因此，胞外核苷酸酶如CD39和CD73的功能活性，其水解促炎性ATP以产生免疫抑制的腺苷，因此在急性炎症中起关键作用。持续的炎症可能会导致异常的腺苷能信号传导，从而维持炎症小体活化并加重纤维化反应。外切核苷酸酶在各种免疫细胞（例如调节性T细胞和巨噬细胞）以及肾脏脉管系统组件上的表达变化，控制着嘌呤能受体介导的对肾脏内靶组织的作用。如本综述中所述，文献越来越多地支持CD39作为变阻器的作用，该变阻剂可对急性和慢性炎症中的嘌呤能信号传导产生影响。更好地了解这些嘌呤能过程和针对这些途径的新药的开发可能会导致治疗急性和慢性肾脏疾病的有效疗法。如本综述中所详述，文献越来越多地支持CD39作为变阻器的作用，该变阻剂可对急性和慢性炎症中的嘌呤能信号传导产生影响。更好地了解这些嘌呤能过程和针对这些途径的新药的开发可能会导致治疗急性和慢性肾脏疾病的有效疗法。如本综述中所述，文献越来越多地支持CD39作为变阻器的作用，该变阻剂可对急性和慢性炎症中的嘌呤能信号传导产生影响。更好地了解这些嘌呤能过程和针对这些途径的新药的开发可能会导致治疗急性和慢性肾脏疾病的有效疗法。