Mayo Clinic Consensus Report on Membranous Nephropathy: Proposal for a Novel Classification

TY - JOUR

T1 - Mayo Clinic Consensus Report on Membranous Nephropathy: Proposal for a Novel Classification

AU - Sethi, Sanjeev

AU - Beck, Laurence H

AU - Glassock, Richard J

AU - Haas, Mark

AU - De Vriese, An S

AU - Caza, Tiffany N

AU - Hoxha, Elion

AU - Lambeau, Gérard

AU - Tomas, Nicola M

AU - Madden, Benjamin

AU - Debiec, Hanna

AU - D'Agati, Vivette D

AU - Alexander, Mariam P

AU - Amer, Hatem

AU - Appel, Gerald B

AU - Barbour, Sean J

AU - Caravaca-Fontan, Fernando

AU - Cattran, Daniel C

AU - Casal Moura, Marta

AU - D'Avila, Domingos O

AU - Eick, Renato G

AU - Garovic, Vesna D

AU - Greene, Eddie L

AU - Herrera Hernandez, Loren P

AU - Jennette, J Charles

AU - Lieske, John C

AU - Markowitz, Glen S

AU - Nath, Karl A

AU - Nasr, Samih H

AU - Nast, Cynthia C

AU - Pani, Antonello

AU - Praga, Manuel

AU - Remuzzi, Giuseppe

AU - Rennke, Helmut G

AU - Ruggenenti, Piero

AU - Roccatello, Dario

AU - Soler, Maria Jose

AU - Specks, Ulrich

AU - Stahl, Rolf A K

AU - Singh, Raman Deep

AU - Theis, Jason D

AU - Velosa, Jorge A

AU - Wetzels, Jack F M

AU - Winearls, Christopher G

AU - Yandian, Federico

AU - Zand, Ladan

AU - Ronco, Pierre

AU - Fervenza, Fernando C

N1 - Copyright © 2023 International Society of Nephrology and Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

PY - 2023/11

Y1 - 2023/11

N2 - Membranous nephropathy (MN) is a pattern of injury caused by autoantibodies binding to specific target antigens, with accumulation of immune complexes along the subepithelial region of glomerular basement membranes. The past 20 years have brought revolutionary advances in the understanding of MN, particularly via the discovery of novel target antigens and their respective autoantibodies. These discoveries have challenged the traditional classification of MN into primary and secondary forms. At least 14 target antigens have been identified, accounting for 80%-90% of cases of MN. Many of the forms of MN associated with these novel MN target antigens have distinctive clinical and pathologic phenotypes. The Mayo Clinic consensus report on MN proposes a 2-step classification of MN. The first step, when possible, is identification of the target antigen, based on a multistep algorithm and using a combination of serology, staining of the kidney biopsy tissue by immunofluorescence or immunohistochemistry, and/or mass spectrometry methodology. The second step is the search for a potential underlying disease or associated condition, which is particularly relevant when knowledge of the target antigen is available to direct it. The meeting acknowledges that the resources and equipment required to perform the proposed testing may not be generally available. However, the meeting consensus was that the time has come to adopt an antigen-based classification of MN because this approach will allow for accurate and specific MN diagnosis, with significant implications for patient management and targeted treatment.

AB - Membranous nephropathy (MN) is a pattern of injury caused by autoantibodies binding to specific target antigens, with accumulation of immune complexes along the subepithelial region of glomerular basement membranes. The past 20 years have brought revolutionary advances in the understanding of MN, particularly via the discovery of novel target antigens and their respective autoantibodies. These discoveries have challenged the traditional classification of MN into primary and secondary forms. At least 14 target antigens have been identified, accounting for 80%-90% of cases of MN. Many of the forms of MN associated with these novel MN target antigens have distinctive clinical and pathologic phenotypes. The Mayo Clinic consensus report on MN proposes a 2-step classification of MN. The first step, when possible, is identification of the target antigen, based on a multistep algorithm and using a combination of serology, staining of the kidney biopsy tissue by immunofluorescence or immunohistochemistry, and/or mass spectrometry methodology. The second step is the search for a potential underlying disease or associated condition, which is particularly relevant when knowledge of the target antigen is available to direct it. The meeting acknowledges that the resources and equipment required to perform the proposed testing may not be generally available. However, the meeting consensus was that the time has come to adopt an antigen-based classification of MN because this approach will allow for accurate and specific MN diagnosis, with significant implications for patient management and targeted treatment.

KW - Humans

KW - Glomerulonephritis, Membranous/diagnosis

KW - Consensus

KW - Autoantibodies

KW - Nephrectomy

KW - Phenotype

U2 - 10.1016/j.mayocp.2023.08.006

DO - 10.1016/j.mayocp.2023.08.006

M3 - Guideline, recommendation, statement

C2 - 37804268

VL - 98

SP - 1671

EP - 1684

JO - MAYO CLIN PROC

JF - MAYO CLIN PROC

SN - 0025-6196

IS - 11

ER -