目的:随着对补体失调研究的深入,以C3沉积为主的肾小球肾炎日益受到关注,其病理类型多样,且病理类型间症状及预后差异具有异质性。为避免误诊及漏诊,本研究分析不同病理类型C3沉积为主的肾小球肾炎的临床、病理及预后特点。方法:回顾性...目的:随着对补体失调研究的深入,以C3沉积为主的肾小球肾炎日益受到关注,其病理类型多样,且病理类型间症状及预后差异具有异质性。为避免误诊及漏诊,本研究分析不同病理类型C3沉积为主的肾小球肾炎的临床、病理及预后特点。方法:回顾性分析52例2013年6月至2022年10月行肾活检诊断为以C3沉积为主肾小球肾炎患者的临床、病理及随访资料。根据临床表现以及病理检查结果分为感染后肾小球肾炎(post-infectious glomerulonephritis,PIGN)组(n=15)和非感染后肾小球肾炎(non-post-infectious glomerulonephritis,N-PIGN)组(n=37)。进一步行N-PIGN亚组分析,分为C3独立沉积组(n=16)与C3复合沉积组(n=21),或C3肾病(C3 glomerulopathy,C3G)组(n=27)与非C3肾病(N-C3G)组(n=10)。结果:PIGN组相较于N-PIGN组,活检时血清肌酐值更低(84.60μmol/L vs 179.62μmol/L,P=0.001),补体C3值更低(0.36 g/L vs 0.74 g/L,P<0.001),病理慢性化病变程度更轻。在N-PIGN亚组分析中,C3复合沉积组较C3独立沉积组血清肌酐值更高(235.30μmol/L vs 106.70μmol/L,P=0.004),24 h尿蛋白值更高(4025.62 mg vs 1981.11 mg,P=0.037)。PIGN组的预后好于N-PIGN组(P=0.049),C3独立沉积组的预后好于C3复合沉积组(P=0.017),C3G组的预后好于N-C3G(P=0.018)。结论:C3沉积为主的肾小球肾炎涵盖多种病理类型,诊断C3G前需先排除PIGN,但对于非典型PIGN患者仍需要警惕C3G叠加或者相互转化;此外,荧光显微镜下经典补体C1q的沉积可能提示肾预后不良,应加强相关诊治与随访。展开更多
C3 glomerulopathy is a disease including both dense deposit disease and C3 glomerulonephritis has an estimated prevalence of 2 to 3 per million. Originally, these pathologies were defined as glomerular pathology chara...C3 glomerulopathy is a disease including both dense deposit disease and C3 glomerulonephritis has an estimated prevalence of 2 to 3 per million. Originally, these pathologies were defined as glomerular pathology characterized by accumulation of C3 with absent or scanty immunoglobulin deposition. The keystone defect in both of these pathologies is the unregulated hyperactivity of alternative complement pathway. Specifically, in C3 glomerulopathy patients, there exists a prolongation of C3 cleavage which causes the uncontrolled alternative pathway activation. Many treatments have been investigated for treating C3 glomerulopathy to little or no avail, including calcineurin inhibitors, plasmapharesis, and anti-CD20 monoclonal antibodies. The next logical step is exploring the efficacy of anti-C5 monoclonal antibody therapy in C3 glomerulopathies to target the specific pathophysiology of this particular disease. Eculizumab is an anti-C5 monoclonal antibody that blocks the terminal step of complement activation. This drug has proven to be an effective treatment in other nephrologic pathologies that are caused by complement dysregulation. Here in this paper we discuss and present various case studies and clinical trials available that experiment with Eculizumab in patients with either dense deposit disease or C3 glomerulonephritis. In most of these patients, treatment with Eculizumab has demonstrated clinical and biochemical improvements in kidney function. These results provide encouraging evidence that suggest Eculizumab as a promising therapy for patients with C3 glomerulopathy and warrant that more extensive clinical trials can be designed as a next step.展开更多
文摘目的:随着对补体失调研究的深入,以C3沉积为主的肾小球肾炎日益受到关注,其病理类型多样,且病理类型间症状及预后差异具有异质性。为避免误诊及漏诊,本研究分析不同病理类型C3沉积为主的肾小球肾炎的临床、病理及预后特点。方法:回顾性分析52例2013年6月至2022年10月行肾活检诊断为以C3沉积为主肾小球肾炎患者的临床、病理及随访资料。根据临床表现以及病理检查结果分为感染后肾小球肾炎(post-infectious glomerulonephritis,PIGN)组(n=15)和非感染后肾小球肾炎(non-post-infectious glomerulonephritis,N-PIGN)组(n=37)。进一步行N-PIGN亚组分析,分为C3独立沉积组(n=16)与C3复合沉积组(n=21),或C3肾病(C3 glomerulopathy,C3G)组(n=27)与非C3肾病(N-C3G)组(n=10)。结果:PIGN组相较于N-PIGN组,活检时血清肌酐值更低(84.60μmol/L vs 179.62μmol/L,P=0.001),补体C3值更低(0.36 g/L vs 0.74 g/L,P<0.001),病理慢性化病变程度更轻。在N-PIGN亚组分析中,C3复合沉积组较C3独立沉积组血清肌酐值更高(235.30μmol/L vs 106.70μmol/L,P=0.004),24 h尿蛋白值更高(4025.62 mg vs 1981.11 mg,P=0.037)。PIGN组的预后好于N-PIGN组(P=0.049),C3独立沉积组的预后好于C3复合沉积组(P=0.017),C3G组的预后好于N-C3G(P=0.018)。结论:C3沉积为主的肾小球肾炎涵盖多种病理类型,诊断C3G前需先排除PIGN,但对于非典型PIGN患者仍需要警惕C3G叠加或者相互转化;此外,荧光显微镜下经典补体C1q的沉积可能提示肾预后不良,应加强相关诊治与随访。
文摘C3 glomerulopathy is a disease including both dense deposit disease and C3 glomerulonephritis has an estimated prevalence of 2 to 3 per million. Originally, these pathologies were defined as glomerular pathology characterized by accumulation of C3 with absent or scanty immunoglobulin deposition. The keystone defect in both of these pathologies is the unregulated hyperactivity of alternative complement pathway. Specifically, in C3 glomerulopathy patients, there exists a prolongation of C3 cleavage which causes the uncontrolled alternative pathway activation. Many treatments have been investigated for treating C3 glomerulopathy to little or no avail, including calcineurin inhibitors, plasmapharesis, and anti-CD20 monoclonal antibodies. The next logical step is exploring the efficacy of anti-C5 monoclonal antibody therapy in C3 glomerulopathies to target the specific pathophysiology of this particular disease. Eculizumab is an anti-C5 monoclonal antibody that blocks the terminal step of complement activation. This drug has proven to be an effective treatment in other nephrologic pathologies that are caused by complement dysregulation. Here in this paper we discuss and present various case studies and clinical trials available that experiment with Eculizumab in patients with either dense deposit disease or C3 glomerulonephritis. In most of these patients, treatment with Eculizumab has demonstrated clinical and biochemical improvements in kidney function. These results provide encouraging evidence that suggest Eculizumab as a promising therapy for patients with C3 glomerulopathy and warrant that more extensive clinical trials can be designed as a next step.
