Precision medicine for the treatment of glomerulonephritis: a bold goal but not yet a transformative achievement

The revolution in our ability to recognize the alterations in fundamental biology brought about by disease has fostered a renewed interest in precision or personalized medicine (‘the right treatment, or diagnostic test, for the right patient at the right time’). This nascent field has been led by oncology, immunohematology and infectious disease, but nephrology is catching up and quickly. Specific forms of glomerulonephritis (GN) thought to represent specific ‘diseases’ have been ‘downgraded’ to ‘patterns of injury’. New entities have emerged through the application of sophisticated molecular technologies, often embraced by the term ‘multi-omics’. Kidney biopsies are now interpreted by next-generation imaging and machine learning. Many opportunities are manifest that will translate these remarkable developments into novel safe and effective treatment regimens for specific pathogenic pathways evoking GN and its progression to kidney failure. A few successes embolden a positive look to the future. A sustained and highly collaborative engagement with this new paradigm will be required for this field, full of hope and high expectations, to realize its goal of transforming glomerular therapeutics from one size fits all (or many) to a true individualized management principle.