Advances in the Inflammatory and Immune-mediated Kidney Disorders (IMKD): From Pathogenesis to Precision Therapy.

INTRODUCTION Inflammatory and immune-mediated kidney disorders (IMKD) comprise a diverse group of renal diseases and are a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. Despite advancements in supportive care, longterm renal outcomes remain suboptimal due to disease heterogeneity and limitations of conventional immunosuppressive therapies.

Methods

A narrative review of recent literature was conducted, focusing on immunological mechanisms, genetic and epigenetic regulation, biomarker innovations, and advancements in targeted biologic therapies. Particular emphasis was given to translational research integrating multi-omics technologies with clinical applications to enhance disease understanding and management.

Results

Advances in immunological research have clarified key pathogenic mechanisms, including autoantibody production, complement system activation, cytokine and chemokine dysregulation, and immune cell imbalance. Emerging biomarkers, such as urinary proteins and exosomal microRNAs, have improved early diagnosis and therapeutic monitoring. Novel therapeutic agents, including B-cell inhibitors, complement inhibitors, and cytokine modulators, demonstrate improved efficacy and safety over traditional treatments. Additionally, molecular profiling and computational tools enable identification of disease endotypes, supporting response- based therapeutic strategies.

Discussion

The integration of molecular insights with clinical practice has significantly enhanced the understanding of IMKD pathogenesis and progression. The use of advanced biomarkers and targeted therapies represents a paradigm shift from generalized immunosuppression to mechanism-specific interventions. However, challenges remain in translating these advances into routine clinical practice, including cost, accessibility, and the need for standardized protocols.

Conclusion

The management of IMKD is evolving toward precision nephrology, emphasising individualised, mechanism-based therapies, biomarker-guided decision-making, and personalized patient care to improve clinical outcomes.