非免疫因素肾病的免疫发病机制

非免疫因素性肾病是指由许多非免疫性因素导致的肾脏损害包括急慢性肾脏局部缺血、蛋白负荷过多、高脂血症、肾大部切除、膀胱输尿管返流、尿路梗阻、多囊肾、糖尿病、年龄老年化、肾盂肾炎、高血压、肾毒性物质（药物和毒物）、血流动力学改变、代谢因素等，此类肾病在临床上越来越常见，是发展成肾间质纤维化的主要因素，其病理变化主要表现为淋巴细胞、巨噬细胞的浸润。发病机制包括RAS系统、ROS系统、免疫发病机制及肾微血管内皮细胞和肾小管上皮细胞损伤导致的免疫活性细胞的浸润及分泌的细胞因子的作用。对于非免疫肾病的治疗主要有：ACEI、ARBs、免疫抑制剂强的松、环磷酰胺、环孢霉素和霉芬酸酯等，研究的热点是共刺激分子。

The immune mechanism of non-immunological renal diseases

The non-immunological renal diseases include many renal injuries caused by non-immunological factors such as acute and chronic ischemia, protein overload, hypercholesterolemia, renal ablation, obstructive uropathy, polycystic kidney disease, diabetes, aging, murine hypertension, and nephrotoxicity. These diseases now are getting more and more common, and are the major causes of renal tubular fibrosis. Renal infiltrations with macrophages and monocytes are the pathological changes. The pathogenesis is related to renin-angiotensin system, reactive oxygen species ,infiltration of immunocompetent cells,and cytokins excreted by these cells. The treatment includes ACEI, ARBs, and immunosuppressant. Now the hotspot is costimulatory molecule.