• Sanjeev Sethi, Laurence H Beck, Richard J Glassock, Mark Haas, An S De Vriese, Tiffany N Caza, Elion Hoxha, Gérard Lambeau, Nicola M Tomas, Benjamin Madden, Hanna Debiec, Vivette D D'Agati, Mariam P Alexander, Hatem Amer, Gerald B Appel, Sean J Barbour, Fernando Caravaca-Fontan, Daniel C Cattran, Casal MouraMartaMDivision of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA., Domingos O D'Avila, Renato G Eick, Vesna D Garovic, Eddie L Greene, Loren P Herrera Hernandez, J Charles Jennette, John C Lieske, Glen S Markowitz, Karl A Nath, Samih H Nasr, Cynthia C Nast, Antonello Pani, Manuel Praga, Giuseppe Remuzzi, Helmut G Rennke, Piero Ruggenenti, Dario Roccatello, Maria Jose Soler, Ulrich Specks, StahlRolf A KRAKIII. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Raman Deep Singh, Jason D Theis, Jorge A Velosa, WetzelsJack F MJFMDepartment of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands., Christopher G Winearls, Federico Yandian, Ladan Zand, Pierre Ronco, and Fernando C Fervenza.
• Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: sethi.sanjeev@mayo.edu.
• Mayo Clin. Proc. 2023 Nov 1; 98 (11): 167116841671-1684.

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

19 keywords...

hide…