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Toxins 2012, 4(11), 962-990; doi:10.3390/toxins4110962
Review

Immune Dysfunction in Uremia—An Update

*  and
Received: 6 August 2012; in revised form: 26 September 2012 / Accepted: 8 October 2012 / Published: 24 October 2012
(This article belongs to the Special Issue Uremic Toxins)
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Abstract: Kidney dysfunction leads to disturbed renal metabolic activities and to impaired glomerular filtration, resulting in the retention of toxic solutes affecting all organs of the body. Cardiovascular disease (CVD) and infections are the main causes for the increased occurrence of morbidity and mortality among patients with chronic kidney disease (CKD). Both complications are directly or indirectly linked to a compromised immune defense. The specific coordinated roles of polymorphonuclear leukocytes (PMNLs), monocytes/macrophages, lymphocytes and antigen-presenting cells (APCs) in maintaining an efficient immune response are affected. Their normal response can be impaired, giving rise to infectious diseases or pre-activated/primed, leading to inflammation and consequently to CVD. Whereas the coordinated removal via apoptosis of activated immune cells is crucial for the resolution of inflammation, inappropriately high apoptotic rates lead to a diminished immune response. In uremia, the balance between pro- and anti-inflammatory and between pro- and anti-apoptotic factors is disturbed. This review summarizes the interrelated parameters interfering with the immune response in uremia, with a special focus on the non-specific immune response and the role of uremic toxins.
Keywords: cardiovascular disease; oxidative stress; inflammation; infection; priming; apoptosis; uremic toxins; polymorphonuclear leukocytes; monocytes; antigen-presenting cells cardiovascular disease; oxidative stress; inflammation; infection; priming; apoptosis; uremic toxins; polymorphonuclear leukocytes; monocytes; antigen-presenting cells
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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MDPI and ACS Style

Cohen, G.; Hörl, W.H. Immune Dysfunction in Uremia—An Update. Toxins 2012, 4, 962-990.

AMA Style

Cohen G, Hörl WH. Immune Dysfunction in Uremia—An Update. Toxins. 2012; 4(11):962-990.

Chicago/Turabian Style

Cohen, Gerald; Hörl, Walter H. 2012. "Immune Dysfunction in Uremia—An Update." Toxins 4, no. 11: 962-990.


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