Nasr Samih H, Royal Virginie, Best Rocha Alejandro, Büttner-Herold Maike, Roufosse Candice, Bridoux Frank, Ismail Wesam, Bu Lihong, Cornell Lynn D, Dendooven Amélie, Gupta Rajib K, Hara Shigeo, Javaugue Vincent, Kozakowski Nicolas, Kudose Satoru, Méndez Gonzalo P, Oliver Kimberley, Picken Maria M, Santoriello Dominick, Sethi Sanjeev, Shimizu Akira, Singh Geetika, Stokes M Barry, Wang Su-Xia, Leung Nelson, Markowitz Glen S, D'Agati Vivette D
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada.
Kidney Int. 2025 Aug;108(2):184-193. doi: 10.1016/j.kint.2025.04.007. Epub 2025 Apr 23.
The spectrum of kidney lesions associated with monoclonal gammopathy has significantly expanded over the past 2 decades, with description of new entities and variants of old entities. Pathologic diagnosis is challenging because of lesional complexity, heterogeneity, and reliance on electron microscopy and ancillary techniques. A lack of precise pathologic definitions and uniform terminology has hampered diagnostic accuracy. To address these challenges, the Renal Pathology Society and International Kidney and Monoclonal Gammopathy Research Group jointly tasked a working group of nephropathologists and nephrologists to establish consensus-based terminology and definitions for monoclonal gammopathy-associated kidney lesions. Participants included experts in the field with international representation. This report presents their recommendations. For each lesion, prerequisite (mandatory) diagnostic criteria and supportive (nonmandatory) features are proposed. New terminology is provided for some lesions. Application of standardized terminology and definitions should help harmonize kidney biopsy diagnosis with precision therapy in the monoclonal gammopathy-associated kidney disorders.
在过去20年中，与单克隆丙种球蛋白病相关的肾脏病变谱显著扩大，出现了新的病变类型以及原有病变类型的变体。由于病变复杂、异质性以及对电子显微镜和辅助技术的依赖，病理诊断颇具挑战性。缺乏精确的病理定义和统一的术语阻碍了诊断准确性。为应对这些挑战，肾脏病理学会和国际肾脏与单克隆丙种球蛋白病研究组联合责成一个由肾病病理学家和肾病学家组成的工作组，为与单克隆丙种球蛋白病相关的肾脏病变建立基于共识的术语和定义。参与者包括来自该领域具有国际代表性的专家。本报告展示了他们的建议。针对每种病变，提出了必备（强制性）诊断标准和支持性（非强制性）特征。为一些病变提供了新术语。标准化术语和定义的应用应有助于使肾脏活检诊断与单克隆丙种球蛋白病相关肾脏疾病的精准治疗相协调。
