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Published on: June 23, 2015
Gene variant C3 glomerulonephritis with chronic urinary tract infection: A case report and literature review
1Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, PR China.
Insights
C3 glomerulonephritis (C3GN) is a rare kidney disease. This case highlights the diagnostic importance of renal biopsy and gene testing for C3GN, even with urinary tract infections, and suggests new treatment avenues.
Area of Science:
- Nephrology
- Complement System Biology
- Glomerular Diseases
Background:
- C3 glomerulonephritis (C3GN) is a rare nephropathy characterized by dysregulation of the alternative complement pathway.
- This review focuses on a unique C3GN case with recurrent urinary tract infections, detailing its clinical course.
Purpose of the Study:
- To report a rare case of C3GN co-occurring with urinary tract infections.
- To summarize the clinical features, diagnostic challenges, treatment strategies, and outcomes in C3GN patients.
Main Methods:
- Diagnosis was confirmed through renal biopsy and genetic testing in a 44-year-old female patient with persistent proteinuria.
- Treatment involved angiotensin II receptor blockers for C3GN and quinolones for UTI, avoiding steroids and immunosuppressants due to patient preference.
Main Results:
- The patient maintained stable serum creatinine, proteinuria, and C3 complement levels during follow-up.
- The case underscores the diagnostic utility of renal biopsy in C3GN.
Conclusions:
- Diagnosing C3GN is challenging due to overlapping conditions like post-infectious glomerulonephritis.
- The role of gram-negative bacilli in C3GN pathogenesis requires further investigation, as does the impact of gene mutations and optimal treatment strategies.
Rationale:
C3 glomerulonephritis (C3GN) is 1 type of C3 nephropathy which is a rare glomerular disease associated with abnormal regulation of the alternative complement pathway. This review reports a rare case of C3GN with repeated urinary tract infection and summarizes the clinical features, differential diagnosis, treatment, and outcome of patients with C3GN.
Patient Concerns:
A 44-year-old woman was admitted to our hospital because of proteinuria increased for more than 8 years.
Diagnoses:
The patient was finally diagnosed with C3GN by renal biopsy and gene testing.
Interventions:
The patient was worried about the side effects of drugs and strongly refused to use glucocorticoids and immunosuppressants, so she was given angiotensin II receptor blocker monotherapy for glomerulonephritis and quinolones for urinary tract infection.
Outcomes:
Serum creatinine, proteinuria, and serum complement c3 levels remained stable. Our case is still under continuous follow-up.
Lessons:
Clinical diagnosis of C3GN is difficult to make as there are many differential diagnoses, especially post infection nephritis. This case emphasizes the importance of renal biopsy in the diagnosis of C3GN, but the relationship between gram-negative bacilli and C3GN is still unclear. In addition, gene mutation is also involved in the pathogenesis of C3GN, and the treatment of C3GN still needs to be explored.
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