Remissions and progression of C3 glomerulopathy

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Abstract

Aim. To analyze the outcomes of C3-glomerulopathy (C3-GP) and determine the associated factors.

Materials and methods. A retrospective single-center study included 60 patients with newly diagnosed C3-GP (with primary C3-GP – pC3-GP – 82%). Of these, 48 (80%) patients had clinical data to assess the following disease outcomes: development of remission and disease progression (by a composite endpoint that included initiation of chronic dialysis or a decrease in estimated glomerular filtration rate – eGFR – <15 mL/min/1.73 m2 or a decrease in eGFR≥30% of baseline at the time of renal biopsy). The median follow-up period was 25 (7; 52) months.

Results. At early follow-up (median 4 [3; 9] months) remission was registered in 35% of patients; at the end of follow-up, in 48% (for pC3-GP, 32 and 41%). Disease progression occurred in 17 patients. In the overall group the likelihood of achieving early remission was higher with treatment (Expβ=6.4, 95% confidence interval – CI 1.4–29.3; p=0.017). Early remission was associated with the presence of remission at the end of follow-up (Expβ=6.3, 95% CI 2.2–18.4; p=0.001). Specific treatment (Expβ=0.308, 95% CI 0.108–0.881; p=0.028) and late remission (Expβ=0.079, 95% CI 0.017–0.368; p=0.001) were associated with reduced risk of disease progression in multivariable models (adjusted for eGFR, mean blood pressure). The same results were obtained for the group of patients with pC3-GP.

Conclusion. C3-GP is a variant of severe complement-mediated glomerular damage with unfavorable renal prognosis, which requires timely personalized expert-level diagnostics with clarification of etiopathogenesis of the disease followed by therapy aimed at achieving remission to improve outcomes.

About the authors

Anna V. Karunnaya

Pavlov First Saint Petersburg State Medical University

Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0003-0758-8137

врач-нефролог, зав. отд-нием хронического гемодиализа клиники Научно-исследовательского института нефрологии

Russian Federation, Saint Petersburg

Vladimir A. Dobronravov

Pavlov First Saint Petersburg State Medical University

Author for correspondence.
Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0002-7179-5520

д-р мед. наук, проф., и.о. дир. клиники Научно-исследовательского института нефрологии, проф. каф. пропедевтики внутренних болезней с клиникой, проф. каф. нефрологии и диализа фак-та последипломного образования

Russian Federation, Saint Petersburg

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2. Fig. 1. Cumulative rates of C3-GP remissions in the early follow-up period with and without treatment: a – all patients; b – with (upper line) and without treatment (lower line), in primary C3-GP.

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3. Fig. 2. Cumulative proportion of cases without progression by composite end-point (renal replacement therapy or eGFR decrease <15 ml/min/1.73 m2 or eGFR decrease ≥30%): a – in the general group; b – and in primary (solid line) or in secondary C3-GP (dash line).

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4. Fig. 3. Cumulative proportion of cases without progression by composite end-point (renal replacement therapy or eGFR decrease <15 ml/min/1.73 m2 or eGFR decrease ≥30%) in patients who achieved (dash lines) and did not achieve (solid lines) remission at the end of follow-up: а – in the general group; b – in primary C3-GP; in treated (dash lines) and untreated patients (solid lines): c – in the general group; d – in primary C3-GP.

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