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KMID : 1102220230420010098
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Kidney Research and Clinical Practice
2023 Volume.42 No. 1 p.98 ~ p.108
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Comparison of dominant and nondominant C3 deposition in primary glomerulonephritis
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Ryu Ji-Won
Baek Eun-Ji
Son Hyung-Eun
Ryu Ji-Young
Jeong Jong-Cheol
Kim Se-Joong
Na Ki-Young
Chae Dong-Wan
KIm Seong-Pyo
Kim Su-Hwan
Jhee Jong-Hyun
Chang Tae-Ik
Choi Bum-Soon
Chin Ho-Jun
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Abstract
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Background: Alternative complement pathway dysregulation plays a key role in glomerulonephritis (GN) and is associated with C3 deposition. Herein, we examined pathological and clinical differences between cases of primary GN with C3-dominant (C3D-GN) and nondominant (C3ND-GN) deposition.
Methods: We extracted primary GN data from the Korean GlomeruloNEphritis sTudy (KoGNET). C3D-GN was defined as C3 staining two grades greater than C1q, C4, and immunoglobulin via immunofluorescence analysis. To overcome a large difference in the number of patients between the C3D-GN and C3ND-GN groups (50 vs. 13,070), permutation testing was used for analysis.
Results: The C3D-GN group exhibited higher serum creatinine (p ≤ 0.001), a greater prevalence of estimated glomerular filtration rate of <60 mL/min/1.72 m2 (p ≤ 0.001), higher (but not significantly so) C-reactive protein level, and lower serum C3 level (p ≤ 0.001). Serum albumin, urine protein/creatinine ratio, number of patients who progressed to end-stage renal disease, and all-cause mortality were comparable between groups. Interstitial fibrosis and mesangial cellularity were greater in the C3D-GN group (p = 0.04 and p = 0.01, respectively) than in the C3ND-GN group. C3 deposition was dominant in the former group (p < 0.001), in parallel with increased subendothelial deposition (p ≤ 0.001).
Conclusion: Greater progression of renal injury and higher mortality occurred in patients with C3D-GN than with C3ND-GN, along with pathologic differences in interstitial and mesangial changes.
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KEYWORD
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Glomerulonephritis, Complement system C3 convertase, Alternative pathway
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