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Updated: Dec 20, 2025

Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Treatment-resistant nephrotic syndrome in dense deposit disease: complement-mediated glomerular capillary wall
Caroline Duineveld1, Eric J Steenbergen2, Andrew S Bomback3
1Department of Nephrology, Radboud University Medical Center, PO BOX 9101, 6500 HB, Nijmegen, Netherlands. caroline.duineveld@radboudumc.nl.
Insights
Dense deposit disease (DDD), a C3 glomerulopathy, involves abnormal complement regulation. Two distinct pathways may cause kidney injury in DDD, one C5-independent and one C5-dependent.
Area of Science:
- Nephrology
- Complement System Biology
- Glomerular Diseases
Background:
- C3 glomerulopathies (C3G) are glomerular diseases stemming from dysregulated complement activation.
- Dense deposit disease (DDD) is a C3G subtype characterized by electron-dense deposits in the glomerular basement membrane.
- DDD patients exhibit hematuria, proteinuria, and kidney dysfunction, with biopsies showing inflammation and proliferation.
Background:
The C3 glomerulopathies (C3G) are recently defined glomerular diseases, attributed to abnormal complement regulation. Dense deposit disease (DDD) is part of the spectrum of C3G, characterized by electron-dense deposits in the lamina densa of the glomerular basement membrane. Patients with DDD present with hematuria, variable degrees of proteinuria, and kidney dysfunction. Kidney biopsies typically disclose proliferative and inflammatory patterns of injury. Treatment with glucocorticoids and mycophenolate mofetil has been shown to achieve remission of proteinuria in a significant proportion of C3G patients.
Case-Diagnosis/Treatment:
We report two patients with persistent nephrotic syndrome while on immunosuppressive therapy. Repeat kidney biopsies disclosed massive C3 deposits with foot process effacement in the absence of proliferative or inflammatory lesions on light microscopy.
Conclusion:
These cases, coupled with data from animal models of disease and the variable response to eculizumab in C3G patients, illustrate that two different pathways might be involved in the development of kidney injury in C3G: a C5-independent pathway leading to glomerular capillary wall injury and the development of proteinuria versus a C5-dependent pathway that causes proliferative glomerulonephritis and kidney dysfunction.
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