CLINICAL MANIFESTATIONS, MORPHOLOGICAL PATTERN AND TREATMENT OUTCOMES OF COMPLEMENT 3 GLOMERULOPATHY ON LONG TERM

Introduction:

C3 glomerulonephritis(C3GN) is a clinicopathologic entity defined by the presence of isolated or dominant deposits of C3 on immunofluorescence. We aimed to study the impact of immunosuppression on C3GN outcomes on follow-up.

Methods:

The study included 111 patients of C3GN with a median follow up of 33 months (maximum 156 months) who reported to the institute between January 2010 to July 2022. All patients were treated with Steroids with and without mycophenolate mofetil (MMF) and their outcomes were compared.

Results:

A total of 111 patients (62 male, median age 32) were included. Of them, 79(71.2%) had hypertension, 80(72.9%) had microscopic hematuria, 17(15%) had macroscopic haematuria, mean eGFR 52.8 ml/min/1.73m2, mean serum creatinine 3.2mg/dl and 24 hour mean proteinuria 4.4gm/day. A total of 33(30%) had the nephrotic syndrome, 31(28%) had RPGN like presentation, 22(20%) had nephrotic-nephritic, and 4(3.6%) had CGN. Histologically, 39(35%) had MPGN pattern.

Out of 103 patients who were treated, 75 patients were grouped into two categories, 45 received steroid and MMF and 30 only steroids. Remission (complete and partial) were more in steroid with MMF (CR=15(33.3%), PR=24(53.3%) as compared to steroid without MMF (CR=8(26.6%), PR=9(30%). On Kaplan-Meier survival analysis, the renal survival was almost similar at 6 months but significantly better in MMF group as compared to non-MMF group, at 12 and 60 months. The Cox Regression Model identified serum creatinine and presence of IFTA (overall and in the range of 25-50%) as a significant predictor of the risk of ESRD, with higher levels associated with an increased risk. Macrohematuria showed a significant protective effect against ESRD. The Cox Regression Model identified serum creatinine as a statistically significant predictor of the risk of death, with higher levels associated with an increased risk.

Conclusions:

Overall remission rate and renal survival was significantly better in group with steroid and MMF as compared to only steroid group. Thus, immunosuppressive treatments, particularly steroid plus MMF, can be beneficial in C3 glomerulonephritis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.