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The role of macrophages during acute kidney injury: destruction and repair

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Abstract

Acute kidney injury (AKI) is defined by a rapid decline in renal function. Regardless of the initial cause of injury, the influx of immune cells is a common theme during AKI. While an inflammatory response is critical for the initial control of injury, a prolonged response can negatively affect tissue repair. In this review, we focus on the role of macrophages, from early inflammation to resolution, during AKI. These cells serve as the innate defense system by phagocytosing cellular debris and pathogenic molecules and bridge communication with the adaptive immune system by acting as antigen-presenting cells and secreting cytokines. While many immune cells function to initiate inflammation, macrophages play a complex role throughout AKI. This complexity is driven by their functional plasticity: the ability to polarize from a “pro-inflammatory” phenotype to a “pro-reparative” phenotype. Importantly, experimental and translational studies indicate that macrophage polarization opens the possibility to generate novel therapeutics to promote repair during AKI. A thorough understanding of the biological roles these phagocytes play during both injury and repair is necessary to understand the limitations while furthering the therapeutic application.

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Acknowledgements

Dr. Hukriede’s laboratory is supported by the National Institutes of Health (NIH) National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) grants 2R01DK069403, 1R01DK112652, 1P30DK079307, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant 2R01HD053287, and the Department of Defense DoD-W81XWH-17-1-0610. Dr. Davidson’s laboratory is supported by the Health Research Council of New Zealand (grants 15/057 & 17/425)

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  1. Department of Developmental Biology, University of Pittsburgh School of Medicine, 3501 5th Ave., 5061 BST3, Pittsburgh, PA, 15213, USA

    Hwa I. Han, Lauren B. Skvarca, Eugenel B. Espiritu & Neil A. Hukriede

  2. Department of Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand

    Alan J. Davidson

  3. Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA

    Neil A. Hukriede

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  1. Hwa I. Han
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Han, H.I., Skvarca, L.B., Espiritu, E.B. et al. The role of macrophages during acute kidney injury: destruction and repair. Pediatr Nephrol 34, 561–569 (2019). https://doi.org/10.1007/s00467-017-3883-1

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