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Mayo Clinic consensus report on membranous nephropathy: proposal for a novel classification
Sanjeev Sethi1, Laurence H Beck2, Richard J Glassock3
1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Kidney International
|October 5, 2023
Summary
Recent discoveries of target antigens have revolutionized the understanding of membranous nephropathy (MN). An antigen-based classification is proposed for accurate diagnosis and targeted treatment of this kidney disease.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Membranous nephropathy (MN) involves immune complex deposition in the kidney glomeruli.
- Advances in identifying target antigens and autoantibodies have transformed MN understanding.
- Over 14 target antigens identified, explaining 80-90% of MN cases.
Purpose of the Study:
- To propose a new, antigen-based classification for membranous nephropathy.
- To highlight the clinical and pathological significance of novel MN target antigens.
- To emphasize the need for accurate diagnosis and targeted treatment in MN.
Main Methods:
- Utilizing a combination of serology, immunofluorescence, immunohistochemistry, and mass spectrometry.
- Implementing a two-step classification algorithm focusing on antigen identification.
- Searching for underlying diseases or associated conditions based on identified antigens.
Main Results:
- Identification of at least 14 target antigens in 80-90% of MN cases.
- Association of novel MN antigens with distinct clinical and pathological features.
- Development of a two-step classification strategy for MN diagnosis.
Conclusions:
- An antigen-based classification offers accurate and specific diagnosis for MN.
- This approach has significant implications for patient management and targeted therapies.
- Adoption of antigen-based classification is recommended despite resource limitations.
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