Research Progress on Intestinal Mucosal Immunity in the Pathogenesis of IgA Nephropathy

IgA肾病是全球最常见的原发性肾小球疾病，其发病机制与半乳糖缺陷型IgA1的产生及其自身抗体的形成密切相关。越来越多的证据表明，肠道作为产生IgA的主要场所，其黏膜免疫系统的异常是IgA肾病的关键始动因素。本综述系统阐述了肠道菌群失调、膳食抗原暴露及肠道疾病等多种因素如何导致肠道黏膜免疫异常，进而驱动IgA肾病的发病。同时，我们针对上述机制，相对应地探讨了其潜在的治疗策略，以期为理解IgA肾病的“肠–肾轴”机制和开发新型疗法提供视角。IgA nephropathy is the most common primary glomerular disease globally, and its pathogenesis is closely related to the production of galactose-deficient IgA1 and the formation of autoantibodies. Increasing evidence suggests that abnormalities in the intestinal mucosal immune system, as the primary site of IgA production, are a key initiating factor in IgA nephropathy. This review systematically elaborates on how various factors, such as intestinal flora imbalance, dietary antigen exposure, and intestinal diseases, can lead to abnormalities in intestinal mucosal immunity, thereby driving the pathogenesis of IgA nephropathy. Simultaneously, we explore potential therapeutic strategies corresponding to the aforementioned mechanisms, aiming to provide insights into understanding the “gut-kidney axis” mechanism of IgA nephropathy and developing novel therapies.