Proliferative glomerulonephritis secondary to dysfunction of the alternative pathway of complement

Sanjeev Sethi, Fernando C. Fervenza, Yuzhou Zhang, Samih H. Nasr, Nelson Leung, Julie Vrana, Carl Cramer, Carla M. Nester, Richard J.H. Smith

Research output: Contribution to journalArticle

107 Scopus citations

Abstract

Background and objectives dense deposit disease (DDD) is the prototypical membranoproliferative glomerulonephritis (MPGN), in which fluid-phase dysregulation of the alternative pathway (AP) of complement results in the accumulation of complement debris in the glomeruli, often producing an MPGN pattern of injury in the absence of immune complexes. A recently described entity referred to as GN with C3 deposition (GN-C3) bears many similarities to DDD. The purpose of this study was to evaluate AP function in cases of GN-C3. Design, setting, participants, & measurements Five recent cases of MPGN with extensive C3 deposition were studied. Renal biopsy in one case exhibited the classic findings of DDD. Three cases showed GN-C3 in the absence of significant Ig deposition; however, the classic hallmark of DDD-dense deposits along the glomerular basement membranes and mesangium-was absent. The remaining case exhibited features of both DDD and GN-C3. Results Evidence of AP activation was demonstrable in all cases and included increased levels of soluble membrane attack complex (all cases), positive AP functional assays (four cases), and a positive hemolytic assay (one case). Autoantibodies were found to C3 convertase (two cases) and to factor H (one case). Factor H mutation screening identified the H402 allele (all cases) and a c.C2867T p.T956M missence mutation (one case). Laser microdissection and mass spectrometry of glomeruli of GN-C3 (two cases) showed a proteomic profile very similar to DDD. Conclusions These studies implicate AP dysregulation in a spectrum of rare renal diseases that includes GN-C3 and DDD.

Original languageEnglish (US)
Pages (from-to)1009-1017
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number5
DOIs
StatePublished - May 1 2011

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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