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Mayo Clinic/Renal Pathology Society Consensus Report on Pathologic Classification, Diagnosis, and Reporting of GN
Sanjeev Sethi1, Mark Haas2, Glen S Markowitz2
1Mayo Clinic, Rochester, Minnesota sethi.sanjeev@mayo.edu fervenza.fernando@mayo.edu.
Insights
A new classification system for glomerulonephritis (GN) based on cause and disease process was established to standardize kidney biopsy reports. This system categorizes GN into five pathogenic types for improved diagnosis and reporting.
Area of Science:
- Nephrology
- Pathology
- Immunology
Background:
- Glomerulonephritis (GN) diagnosis and reporting lack standardization, hindering consistent patient care and research.
- Existing classification systems do not fully capture the underlying etiology or pathogenesis of GN.
Framework:
- A novel etiology/pathogenesis-based classification system for GN was developed, categorizing it into five distinct pathogenic types: immune-complex GN, pauci-immune GN, anti-glomerular basement membrane GN, monoclonal immunoglobulin GN, and C3 glomerulopathy.
- This classification serves as the foundation for standardized kidney biopsy reporting.
Implementation:
- Standardized kidney biopsy reports now include a primary diagnosis (disease entity/pathogenic type, pattern of injury, grading/scoring) and a secondary diagnosis for coexisting lesions.
- Guidelines for report format, light microscopy, immunofluorescence, electron microscopy, and ancillary studies were established.
Implications:
- This consensus report promotes a unified approach to GN classification and reporting, enhancing diagnostic accuracy and interdisciplinary communication.
- Standardized reporting facilitates better understanding of GN pathogenesis, leading to improved clinical management and research outcomes.
Abstract:
Renal pathologists and nephrologists met on February 20, 2015 to establish an etiology/pathogenesis-based system for classification and diagnosis of GN, with a major aim of standardizing the kidney biopsy report of GN. On the basis of etiology/pathogenesis, GN is classified into the following five pathogenic types, each with specific disease entities: immune-complex GN, pauci-immune GN, antiglomerular basement membrane GN, monoclonal Ig GN, and C3 glomerulopathy. The pathogenesis-based classification forms the basis of the kidney biopsy report. To standardize the report, the diagnosis consists of a primary diagnosis and a secondary diagnosis. The primary diagnosis should include the disease entity/pathogenic type (if disease entity is not known) followed in order by pattern of injury (mixed patterns may be present); score/grade/class for disease entities, such as IgA nephropathy, lupus nephritis, and ANCA GN; and additional features as detailed herein. A pattern diagnosis as the sole primary diagnosis is not recommended. Secondary diagnoses should be reported separately and include coexisting lesions that do not form the primary diagnosis. Guidelines for the report format, light microscopy, immunofluorescence microscopy, electron microscopy, and ancillary studies are also provided. In summary, this consensus report emphasizes a pathogenesis-based classification of GN and provides guidelines for the standardized reporting of GN.
