The term glomerulonephritis (GN) describes immune-mediated disorders of the kidney’s filtration units (the glomeruli). Current classifications are based on histopathological lesion patterns. However, different underlying conditions can lead to similar tissue injury and lesions but the respective therapy depends on the underlying disease. To this end, a new classification should involve the cause of GN. The five proposed categories comprise infection-related GN, autoimmune GN, alloimmune GN, autoinflammatory GN, and monoclonal gammopathy-related GN. Making the correct diagnosis can involve numerous different avenues of diagnostics beyond or even without a kidney biopsy. Additionally, dissecting activity from chronicity in GN and considering other systemic disorders and risk factors of an individual is essential to trigger different therapies. With the assessment of now available disease activity markers immunomodulatory drugs should be used for the active phase and long-term renoprotective drugs in chronic conditions. Taken together, the proposed classification aims to improve our understanding, the diagnosis and treatment of glomerulonephritis and might pave the way to next generation patient individual precision medicine.
Klaus et al. (2025) studied this question.