Artificial intelligence in membranous nephropathy: transforming clinical management toward precision medicine

Membranous Nephropathy (MN) is the leading cause of primary nephrotic syndrome in adults, characterized by significant clinical heterogeneity ranging from spontaneous remission to end-stage kidney disease. Current management of membranous nephropathy, which relies heavily on renal biopsy and static serological markers such as anti-PLA2R antibodies, often fails to predict individual disease trajectories. This limitation frequently leads to empirical immunosuppressive therapy with a trial-and-error approach. This review explores the transformative potential of Artificial Intelligence (AI) in reshaping MN management from evidence-based to data-driven and predictive medicine. We examine AI-driven innovations across the clinical spectrum: from computational pathology systems that automate glomerular morphometry with high objectivity and reproducibility, to non-invasive diagnostic models integrating radiomics and serology for non-invasive diagnosis. In therapeutics, we discuss machine learning algorithms that predict individual responses to Rituximab versus Cyclophosphamide, enabling personalized regimen selection. Furthermore, we highlight the role of AI in prognostic stratification, where dynamic in silico patient models and multi-omics integration unravel molecular subtypes and forecast renal survival with high granularity. While acknowledging critical challenges such as data silos, model interpretability gaps, and the need for global validation, we conclude that AI serves as a powerful augmentation tool. By synthesizing high-dimensional data into actionable insights, AI has the potential to facilitate increasingly predictive, preventative, and personalized care strategies in MN management.