Navigating renal safety in the biologic treatment of psoriasis: from immunologic mechanisms to clinical practice

Psoriasis is a common chronic inflammatory skin disorder frequently accompanied by multisystem involvement, with increasing concern regarding its association with renal impairment. The advent and widespread use of biologic agents in the treatment of moderate to severe psoriasis have transformed therapeutic strategies, yet their effects on renal function and the underlying mechanisms remain a critical area of investigation. This review synthesizes current clinical and experimental evidence on the renal impact of biologics used in psoriasis management, focusing on the safety profiles of different biologic classes and their roles in modulating kidney-related complications. We explore how immune regulation, inflammation suppression, and cell death pathways contribute to both renal protection and injury, highlighting the influence of tumor necrosis factor (TNF)-α inhibitors, interleukin (IL) -17 and IL-12/23 inhibitors. By integrating recent clinical studies and basic research findings, this article aims to provide clinicians with a theoretical basis for the rational selection of biologic therapies in psoriasis patients with renal concerns and to stimulate further research into optimizing treatment strategies that safeguard kidney health.