Contribution of immune and non-immune mechanisms to the development of chronic kidney disease
A.E. Stanchuliak, T.N. Krasnova, O.A. Georginova, E.A. Shakhnova, A.V. Osipova, V.G. Avdeev, Yu.A. Manuilova, E.P. Pavlikova
Introduction. Chronic kidney disease (CKD) develops as an outcome both of immune-mediated glomerulonephritides and predominantly metabolic or hemodynamic nephropathies. Despite differences in etiology, common pathogenetic mechanisms are involved in CKD progression, including metabolic disturbances, immune inflammation, and development of glomerulosclerosis.
Objective: To determine the contribution of immune and non-immune (hemodynamic and metabolic) mechanisms to the development of chronic kidney disease (CKD).
Materials and methods. A single-center retrospective analysis of 119 patients with CKD who underwent kidney biopsy was performed. Based on the totality of clinicopathological features (type of glomerulopathy, pattern of immune deposits), patients were divided into two groups: predominantly immune-mediated lesions (n = 72) and predominantly non-immune lesions (n = 47). Clinical and laboratory parameters, 24-hour proteinuria, urinalysis data, as well as morphological indices of inflammatory activity and glomerulosclerosis were analyzed.
Results. In the overall cohort, the presence of arterial hypertension was associated with higher 24-hour proteinuria, increased blood urea and creatinine levels, and reduced estimated glomerular filtration rate (eGFR); patients also had more pronounced interstitial infiltration and a higher degree of glomerulosclerosis. Metabolic syndrome, diabetes mellitus, and obesity were accompanied by increased 24-hour proteinuria and thickening of the glomerular basement membranes, but were not associated with eGFR. In patients with predominantly non-immune lesions, the presence of immune deposits on immunofluorescence and high morphological inflammatory activity were associated with more pronounced eGFR decline, azotemia, electrolyte disturbances, greater proteinuria, and anemia. In the group with predominantly immune-mediated lesions, CKD severity was determined mainly by the degree of glomerulosclerosis and the presence of arterial hypertension, whereas indices of morphological inflammatory activity were not associated with nitrogen-excreting kidney function.
Conclusion. In the progression of CKD in patients with biopsy-proven nephropathies, arterial hypertension, the extent of glomerulosclerosis, and inflammatory activity in renal tissue play a key role. For predominantly non-immune nephropathies, immune deposits and high morphological inflammatory activity are of greatest importance, whereas in predominantly immune glomerulopathies CKD severity is largely determined by chronic changes (glomerulosclerosis) and the presence of hypertension.
For citation: Stanchuliak AE, Krasnova TN, Georginova OA, Shakhnova EA, Osipova AV, Avdeev VG, Manuilova YuA, Pavlikova EP. Contribution of immune and non-immune mechanisms to the development of chronic kidney disease. Therapy (Moscow). 2026;12(5S):31–38.
https://doi.org/10.18565/therapy.2026.5-s5.31-38
Ключевые слова
chronic kidney disease
metabolic disorders
chronic glomerulonephritis
metabolic nephropathies
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Об авторах / Для корреспонденции
Anton E. Stanchuliak, MD, resident physician at the Department of internal medicine, Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.E-mail: anton-ctanch@yandex.ru
ORCID: https://orcid.org/0009-0007-6744-1096. eLibrary SPIN: 2274-1727
Tatyana N. Krasnova, MD, PhD (Medicine), associate professor, head and leading researcher at the Department of internal medicine, Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.
E-mail: krasnovamgu@yandex.ru
ORCID: https://orcid.org/0000-0001-6175-1076. eLibrary SPIN: 5524-6595;
Olga A. Georginova, MD, PhD (Medicine), associate professor, senior researcher at Department of internal medicine, Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.
E-mail: olga.georginova@gmail.com
ORCID: https://orcid.org/0000-0002-7542-8189. Scopus ID: 12779903300. eLibrary SPIN: 8331-3656
Elena A. Shakhnova, MD, PhD (Medicine), head of Nephrology Department, Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.
E-mail: elena_shakhnova@mail.ru
ORCID: https://orcid.org/0000-0002-4462-0653
Alesya V. Osipova, MD, nephrologist at Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.
E-mail: alesyao@list.ru
ORCID: https://orcid.org/0000-0002-0409-8637
Vladimir G. Avdeev, MD, PhD (Medicine), associate professor, senior researcher at Department of internal medicine, Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.
E-mail: avdeevvg@gmail.com
ORCID: https://orcid.org/0000-0001-7901-6635
Yuliya A. Manuilova, MD, PhD (Medicine), head of Endocrinology Department, Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.
E-mail: juliakolish@yahoo.com
ORCID https://orcid.org/0000-0001-7210-1853
Elena P. Pavlikova, MD, Dr. Sci. (Medicine), deputy director for clinical affairs, chief physician of the Medical Research and Education Institute of Lomonosov Moscow State University, Moscow, Russian Federation.
E-mail: elena.pavlikova@inbox.ru
ORCID: https://orcid.org/0000-0001-7693-5281
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