Standardized Classification and Reporting of Glomerulonephritis

Sanjeev Sethi; Fernando C. Fervenza

Disclosures

Nephrol Dial Transplant. 2019;34(2):193-199. 

In This Article

What More can be Done and What Lies in the Future?

The Answer Lies in Detection of the Complement Proteins and Pathway of Complement Involved in GN

Activation of the complement pathways plays an important role in mediating inflammation. In GN, the classical pathway, lectin pathway and alternative pathway of complement have all been shown to be involved, depending on the etiology of the GN. Large amounts of both inactive and active complement protein split fragments are detected in the glomeruli. New drugs are now available that target the various complement pathways. By using a basic set of fluorescently tagged antibodies to various split products of complement proteins, we should be able to identify the pathways involved and the complement proteins that have accumulated in the glomeruli and are likely driving the GN. The complement pathways involved could then be incorporated into the biopsy report.

Conclusion

The biopsy report should be able to answer the questions asked by the nephrologist: the etiologic diagnosis of GN and the activity and chronicity of the lesion and any secondary lesions that might be present. In order to answer these questions, the kidney biopsy diagnosis should be formatted logically and sequentially to include the etiology, activity, class/grade of an established classification system, ancillary studies if done, secondary lesions and chronicity score. This will enable the nephrologist to effectively evaluate, treat and manage patients with GN.

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