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American Journal of Kidney Diseases

Etiology-Based Diagnostic Approach to Proliferative Glomerulonephritis

  • Sanjeev Sethi
    Correspondence
    Address correspondence to Sanjeev Sethi, MD, PhD, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
    Affiliations
    Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Published:January 02, 2014DOI:https://doi.org/10.1053/j.ajkd.2013.11.019
      Proliferative glomerulonephritis (GN) often is classified based on the pattern of injury. The pattern of injury does not reveal the underlying cause. New insights into the causes of proliferative GN suggest that determining the type of deposits is more likely to provide clues to the underlying cause than determining the pattern of injury. This article proposes a new classification of proliferative GN that links findings from both immunofluorescence and light microscopy. The basis of the classification is whether the proliferative GN is immune complex mediated, pauci-immune, or complement mediated; the type of immunoglobulin deposits and complement factors then determine or suggest the underlying cause. One of the aims of the proposed classification system is to focus on the pathophysiology of the GN with emphasis on the underlying cause, leading to appropriate evaluation and management. The second aim is to simplify and standardize the classification of proliferative GN.

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      References

        • Sethi S.
        • Fervenza F.C.
        Membranoproliferative glomerulonephritis: a new look at an old entity.
        N Engl J Med. 2012; 366: 1119-1131
        • Sethi S.
        • Fervenza F.C.
        Membranoproliferative glomerulonephritis: pathogenetic heterogeneity and proposal for a new classification.
        Semin Nephrol. 2011; 31: 341-348
        • Sethi S.
        • Rajkumar S.V.
        Monoclonal gammopathy-associated proliferative glomerulonephritis.
        Mayo Clin Proc. 2013; 88: 1284-1293
        • Falk R.
        • Jennette J.
        A nephrological view of the classification of vasculitis.
        Adv Exp Med Biol. 1993; 336: 197-208
        • Fervenza F.C.
        • Smith R.J.H.
        • Sethi S.
        Association of a novel complement factor H mutation with severe crescentic and necrotizing glomerulonephritis.
        Am J Kidney Dis. 2012; 60: 126-132
        • Sethi S.
        • Fervenza F.C.
        • Zhang Y.
        • et al.
        Atypical postinfectious glomerulonephritis is associated with abnormalities in the alternative pathway of complement.
        Kidney Int. 2013; 83: 293-299
        • Zand L.
        • Kattah A.
        • Fervenza F.C.
        • et al.
        C3 glomerulonephritis associated with monoclonal gammopathy: a case series.
        Am J Kidney Dis. 2013; 62: 506-514