Introduction:
C3 glomerulopathy is a clinicopathologic entity with variable presentations. It is a prototype illness for complement-mediated glomerulonephritis. Immunosuppressive medications, especially mycophenolate mofetil, have shown somewhat promising results in a few studies. Data from the Indian subcontinent are scarce; therefore, we are presenting a study from a North Indian tertiary care hospital comprising patients with C3 glomerulopathy.
Methods:
In this study, we analyzed a total of 118 patients with C3 glomerulopathy (C3GN) from 2014 to 2024. Clinical information and laboratory investigations were reviewed, outcomes were assessed, and serum C3 levels at presentation and during follow-up were measured.
Results:
In this cohort of 118 C3GN patients, 66% were male, with a mean age at presentation of 29±15.7 years. The mean creatinine level was 4.2±4.45 mg/dL, the mean serum albumin was 2.8±0.8 g/dL, and the mean 24-hour urinary protein excretion was 4.4±2.7 g/24 hours. The mean C3 level at presentation was 73±45.8. At presentation, 1 patient had AKI, 1 had subnephrotic proteinuria, 1 had isolated hematuria. 51 (43.2%) presented with nephritic syndrome, 37 (31.4%) with nephroto-nephritic syndrome, and 26 (22%) with nephrotic syndrome. During follow-up, the mean creatinine level was 3.75±3.55 mg/dL, mean serum albumin was 3.45±0.91 g/dL, and mean C3 was 95.7±38.5. Histopathological diagnoses included MPGN C3GN in 87 patients (73.7%), C3GN with crescents in 8 (6.7%), crescentic GN in 7 (5.9%), and DGGS with C3GN in 16 (5.1%). Steroid therapy was given to 89 patients (75.4%), mycophenolate mofetil to 34 (29%), calcineurin inhibitors to 5 (4.2%), rituximab to 7 (5.9%), azathioprine to 1, and cyclophosphamide to 34 (28.8%), while 23 patients (19.4%) received conservative treatment. Among the 15 patients with C3GN with crescents, 4 were treated with mycophenolate mofetil, and 10 with cyclophosphamide, resulting in renal survival in 1 and 3 patients, respectively. The median follow-up period in our study was 12 months (IQR: 5-19.5 months). Renal failure occurred in 37 patients (31.3%), complete remission in 25 (21.2%), and partial remission in 24 (20.3%). Renal survival was observed in 65 (55.1%) of the C3GN patients.
Conclusions:
In our cohort, the most common presentation was nephritic syndrome, typically associated with histopathological features of the MPGN pattern. Renal failure was observed in 31.3% of patients, with particularly poor outcomes in those with C3GN with crescents.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.