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The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
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Complement blockade in ANCA-associated vasculitis: an index case, current concepts and future perspectives.

Lucio Manenti1, Maria Letizia Urban2, Federica Maritati2

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Complement alternative pathway (cAP) hyperactivation is implicated in ANCA-associated vasculitis (AAV). Eculizumab, a C5 inhibitor, successfully treated a severe AAV case with acute kidney injury, highlighting complement-targeted therapy

Keywords:
ANCAComplementEculizumabGlomerulonephritisVasculitis

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Area of Science:

  • Nephrology
  • Immunology
  • Rheumatology

Background:

  • ANCA-associated vasculitis (AAV) is linked to complement alternative pathway (cAP) hyperactivation.
  • Severe cAP activation can lead to acute renal failure in AAV patients.

Purpose of the Study:

  • To report a case of AAV with severe cAP hyperactivation and acute kidney injury.
  • To evaluate the efficacy of eculizumab in treating AAV refractory to standard immunosuppression.
  • To review complement-targeted therapies for AAV.

Main Methods:

  • Case report of an AAV patient with severe cAP activation and acute renal failure.
  • Treatment with standard immunosuppressive therapy followed by eculizumab (anti-C5 monoclonal antibody).
  • Literature review on complement-targeted therapies in AAV.

Main Results:

  • The patient presented with severe cAP hyperactivation and acute renal failure without identifiable predisposing mutations.
  • Standard immunosuppression was ineffective; however, adding eculizumab led to disease reversal and near-complete renal function recovery.
  • Literature review supports the role of complement inhibition in AAV.

Conclusions:

  • Eculizumab is a promising therapeutic option for severe AAV cases with cAP hyperactivation and renal failure.
  • Complement-targeted therapy, specifically C5 inhibition, can effectively manage AAV.
  • Further research into complement's role in AAV pathogenesis and treatment is warranted.