C3 glomerulopathy — understanding a rare complement-driven renal disease

Richard J.H. Smith, Gerald B. Appel, Anna M. Blom, H. Terence Cook, Vivette D. D’Agati, Fadi Fakhouri, Véronique Fremeaux-Bacchi, Mihály Józsi, David Kavanagh, John D. Lambris, Marina Noris, Matthew C. Pickering, Giuseppe Remuzzi, Santiago Rodriguez de Córdoba, Sanjeev M Sethi, Johan Van der Vlag, Peter F. Zipfel, Carla M. Nester

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

The C3 glomerulopathies are a group of rare kidney diseases characterized by complement dysregulation occurring in the fluid phase and in the glomerular microenvironment, which results in prominent complement C3 deposition in kidney biopsy samples. The two major subgroups of C3 glomerulopathy — dense deposit disease (DDD) and C3 glomerulonephritis (C3GN) — have overlapping clinical and pathological features suggestive of a disease continuum. Dysregulation of the complement alternative pathway is fundamental to the manifestations of C3 glomerulopathy, although terminal pathway dysregulation is also common. Disease is driven by acquired factors in most patients — namely, autoantibodies that target the C3 or C5 convertases. These autoantibodies drive complement dysregulation by increasing the half-life of these vital but normally short-lived enzymes. Genetic variation in complement-related genes is a less frequent cause. No disease-specific treatments are available, although immunosuppressive agents and terminal complement pathway blockers are helpful in some patients. Unfortunately, no treatment is universally effective or curative. In aggregate, the limited data on renal transplantation point to a high risk of disease recurrence (both DDD and C3GN) in allograft recipients. Clinical trials are underway to test the efficacy of several first-generation drugs that target the alternative complement pathway.

Original languageEnglish (US)
JournalNature Reviews Nephrology
DOIs
StatePublished - Jan 1 2019

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Membranoproliferative Glomerulonephritis
Alternative Complement Pathway
Kidney
Glomerulonephritis
Autoantibodies
Complement C3-C5 Convertases
Complement C3
Kidney Diseases
Immunosuppressive Agents
Rare Diseases
Kidney Transplantation
Allografts
Half-Life
Clinical Trials
Biopsy
Recurrence
Enzymes
Therapeutics
Pharmaceutical Preparations
Genes

ASJC Scopus subject areas

  • Nephrology

Cite this

Smith, R. J. H., Appel, G. B., Blom, A. M., Cook, H. T., D’Agati, V. D., Fakhouri, F., ... Nester, C. M. (2019). C3 glomerulopathy — understanding a rare complement-driven renal disease. Nature Reviews Nephrology. https://doi.org/10.1038/s41581-018-0107-2

C3 glomerulopathy — understanding a rare complement-driven renal disease. / Smith, Richard J.H.; Appel, Gerald B.; Blom, Anna M.; Cook, H. Terence; D’Agati, Vivette D.; Fakhouri, Fadi; Fremeaux-Bacchi, Véronique; Józsi, Mihály; Kavanagh, David; Lambris, John D.; Noris, Marina; Pickering, Matthew C.; Remuzzi, Giuseppe; de Córdoba, Santiago Rodriguez; Sethi, Sanjeev M; Van der Vlag, Johan; Zipfel, Peter F.; Nester, Carla M.

In: Nature Reviews Nephrology, 01.01.2019.

Research output: Contribution to journalReview article

Smith, RJH, Appel, GB, Blom, AM, Cook, HT, D’Agati, VD, Fakhouri, F, Fremeaux-Bacchi, V, Józsi, M, Kavanagh, D, Lambris, JD, Noris, M, Pickering, MC, Remuzzi, G, de Córdoba, SR, Sethi, SM, Van der Vlag, J, Zipfel, PF & Nester, CM 2019, 'C3 glomerulopathy — understanding a rare complement-driven renal disease', Nature Reviews Nephrology. https://doi.org/10.1038/s41581-018-0107-2
Smith, Richard J.H. ; Appel, Gerald B. ; Blom, Anna M. ; Cook, H. Terence ; D’Agati, Vivette D. ; Fakhouri, Fadi ; Fremeaux-Bacchi, Véronique ; Józsi, Mihály ; Kavanagh, David ; Lambris, John D. ; Noris, Marina ; Pickering, Matthew C. ; Remuzzi, Giuseppe ; de Córdoba, Santiago Rodriguez ; Sethi, Sanjeev M ; Van der Vlag, Johan ; Zipfel, Peter F. ; Nester, Carla M. / C3 glomerulopathy — understanding a rare complement-driven renal disease. In: Nature Reviews Nephrology. 2019.
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