Remissions and progression of C3 glomerulopathy

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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.

作者简介

Anna 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

俄罗斯联邦, Saint Petersburg

Vladimir Dobronravov

Pavlov First Saint Petersburg State Medical University

编辑信件的主要联系方式.
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

俄罗斯联邦, 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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