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Eculizumab as a New Treatment for Severe Acute Post-infectious Glomerulonephritis: Two Case Reports

Hassib Chehade1, Gabriella Guzzo2,3,4, Francois Cachat1

  • 1Department of Paediatrics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.

Frontiers in Medicine
|August 12, 2021
PubMed

Insights

Acute post-infectious glomerulonephritis (APIGN) can cause severe kidney damage. Eculizumab effectively treated two children with severe APIGN, restoring kidney function and preventing dialysis.

Area of Science:

  • Nephrology
  • Immunology
  • Pediatrics

Background:

  • Acute post-infectious glomerulonephritis (APIGN) is a common cause of acute kidney injury in children, potentially leading to chronic kidney disease.
  • Pathophysiology of APIGN is not fully understood, but complement system activation, particularly the alternative pathway, is implicated.
  • C5 blockade has shown potential therapeutic benefits in APIGN, especially with specific autoantibodies.

Observation:

  • Two children with severe APIGN and advanced renal failure were treated with eculizumab.
  • The first patient had anuria, low C3, high soluble C5b-9, and a C3 Nephritic Factor (C3Nef) autoantibody.
  • The second patient presented with oliguric APIGN and low C3 levels.

Findings:

  • Kidney biopsies confirmed APIGN in both cases.
  • Eculizumab treatment led to complete recovery of renal function in both children.
  • Dialysis was successfully avoided in both treated patients.

Implications:

  • Activation of alternative and terminal complement pathways may be a common mechanism in APIGN.
  • Eculizumab represents a promising therapeutic option for severe cases of APIGN.
  • Further research into complement-targeted therapies for APIGN is warranted.

Keywords:
anti-c5 monoclonal antibodycase reporteculizumabpost-infectious glomerulonephritisterminal complement pathway blockage

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