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Updated: Apr 5, 2026

Methods for Quantitative Detection of Antibody-induced Complement Activation on Red Blood Cells

Methods for Quantitative Detection of Antibody-induced Complement Activation on Red Blood Cells

Published on: January 29, 2014

Complement in ANCA-associated glomerulonephritis.

Marc Hilhorst¹, Pieter van Paassen^1,2, Henk van Rie^1,3

¹Clinical & Experimental Immunology, Cardiovascular Research Centre Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association

|August 16, 2015

Summary

Complement activation, particularly via the alternative pathway, is implicated in ANCA-associated glomerulonephritis, even without visible immune deposits. C3d and properdin staining correlate with more severe kidney damage in these patients.

Keywords:

ANCA complement glomerulonephritis renal biopsy

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Area of Science:

Nephrology
Immunology
Pathology

Background:

Anti-neutrophil cytoplasmic antibodies (ANCA) are linked to pauci-immune necrotizing crescentic glomerulonephritis.
The role of complement in ANCA-associated vasculitis (AAV) was previously underestimated.
Recent studies suggest complement inhibition reduces glomerular damage in AAV mouse models.

Purpose of the Study:

To investigate whether immune complex formation or deposition triggers complement activation in ANCA-associated glomerulonephritis.
To explore the role of the complement system in the pathogenesis of AAV.

Main Methods:

Analysis of renal histology, immunoglobulin, and complement immunofluorescence in ANCA-positive patients.
Staining for C3d, properdin, C4d, and mannose-binding lectin (MBL).
Electron microscopy and assessment of circulating immune complexes and C3 allotypes.

Main Results:

C3c and C3d deposition was observed in a significant portion of AAV renal biopsies, varying between PR3-AAV and MPO-AAV.
Properdin staining was more prevalent in biopsies with crescentic features.
Biopsies positive for C3d and/or properdin showed increased cellular crescents and reduced normal glomeruli.

Conclusions:

Immune complex deposits were largely absent in AAV renal biopsies, suggesting rapid degradation.
Complement activation, indicated by C3d, C4d, and C5b-9 staining, is common in AAV.
Findings support the hypothesis of predominant alternative pathway activation in AAV pathogenesis.