There continues to be rapid advancement in our understanding of the pathogenesis of immune-mediated kidney disease. This progress has culminated in the development of multiple therapeutic agents that have consistently improved renal and patient outcomes. The focus of this review is to discuss these recent advancements in immune-mediated kidney disease via the lens of direct and indirect immune-mediated mechanisms. In the direct immune-mediated disease, recently described antigens in anti–glomerular basement membrane (GBM) disease and membranous nephropathy are discussed, along with new therapeutic regimens in membranous nephropathy and focal segmental glomerulosclerosis. From an indirect immune-mediated disease standpoint, recent pivotal trials in antineutrophil cytoplasmic antibody vasculitis, lupus nephritis, and IgA nephropathy are examined from a real-world practice perspective. New molecular pathways in various disorders of alternate complement pathway are described, which in turn have led to development of various experimental therapies. In addition, pivotal and ongoing therapeutic trials in the aforementioned diseases are presented.

我们对免疫介导的肾脏疾病发病机制的理解持续快速发展。这一进展最终导致了多种治疗药物的开发，这些药物持续改善了肾脏和患者的预后。本综述的重点是通过直接和间接免疫介导机制的视角讨论免疫介导肾脏疾病的这些最新进展。在直接免疫介导的疾病中，讨论了最近描述的抗肾小球基底膜 (GBM) 疾病和膜性肾病中的抗原，以及膜性肾病和局灶节段性肾小球硬化的新治疗方案。从间接免疫介导疾病的角度来看，最近在抗中性粒细胞胞质抗体血管炎、狼疮性肾炎、和 IgA 肾病从现实世界的实践角度进行检查。描述了替代补体途径的各种疾病中的新分子途径，这反过来又导致了各种实验疗法的发展。此外，还介绍了上述疾病的关键和正在进行的治疗试验。