Kidney Res Clin Pract.
2023 Jan;42(1):98-108. 10.23876/j.krcp.22.042.
Comparison of dominant and nondominant C3 deposition in primary glomerulonephritis
- Ryu J
1 - Baek E1
- Son HE1
- Ryu JY1
- Jeong JC1,5
- Kim S1,5
- Na KY1,5
- Chae DW1,5
- Kim SP2
- Kim SH3
- Jhee JH4
- Chang TI5
- Choi BS6
- Chin HJ1,7
- on behalf of the Korean GlomeruloNEphritis sTudy (KoGNET) Group1
- Affiliations
-
- 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- 2Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
- 3Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- 4Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- 5Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- 6Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- 7Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- KMID: 2540186
- DOI: http://doi.org/10.23876/j.krcp.22.042
Abstract
- 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 (31 vs. 9,689), 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.
