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Clinical features and outcomes of immune complex-membranoproliferative glomerulonephritis and C3 glomerulopathy: a
SungYeon Kim1, Young Eun Choi2, Sung Gyun Kim3,4
1Division of Nephrology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea.
Background:
Membranoproliferative glomerulonephritis (MPGN) has two subtypes based on immunofluorescence findings: complement 3 glomerulopathy (C3G) and immune complex-mediated MPGN (IC-MPGN). This study investigated the characteristics and prognosis of patients with MPGN.
Methods:
This retrospective study analyzed data from 18 hospitals between 1979 and 2018. Among 21,697 patients, 620 were diagnosed with MPGN, 570 with IC-MPGN, and 50 with C3G.
Results:
The C3G group had a lower estimated glomerular filtration rate (eGFR; 49.9 ± 40.7 mL/min/1.73 m2 vs. 62.7 ± 36.5 mL/min/1.73 m2, p = 0.02) compared with the IC-MPGN group. This trend continued at 6 months: patients with reduced renal function were 36.7% in the C3G group (p = 0.11). However, the IC-MPGN group had significantly higher levels of proteinuria (4.7 ± 4.2 g/g vs. 2.9 ± 2.6 g/g, p < 0.001). The 50.7% of patients with IC-MPGN had nephrotic-range proteinuria. Serum C3 levels were significantly lower in the C3G group (p = 0.04). Hepatitis B surface antigen positivity was significantly more frequent in the IC-MPGN group (35.3% vs. 7.0%, p < 0.001). Interstitial fibrosis and tubular atrophy, markers of chronic kidney damage, were more prevalent in the IC-MPGN group (p ≤ 0.001). During a follow-up period of 122.4 ± 124.2 months, a total of 159 patients (27.7%) with MPGN progressed to end-stage kidney disease (ESKD): 151 IC-MPGN (28.4%) and eight C3G patients (19.0%) (p = 0.28). The adjusted risk of 40% eGFR decline, ESKD, and mortality was not different between groups.
Conclusion:
The C3G group initially showed severe renal dysfunction. Despite having fewer chronic histological findings, the long-term renal outcomes for C3G remained as unfavorable as those for IC-MPGN. This suggests that C3G may require careful monitoring and treatment.
Insights
Membranoproliferative glomerulonephritis (MPGN) subtypes, C3G and IC-MPGN, show similar long-term kidney outcomes despite initial differences in renal function and histology. C3G patients experienced more severe initial dysfunction but comparable progression to end-stage kidney disease.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Membranoproliferative glomerulonephritis (MPGN) comprises two main subtypes: complement 3 glomerulopathy (C3G) and immune complex-mediated MPGN (IC-MPGN).
- Distinguishing between these MPGN subtypes is crucial for understanding disease characteristics and prognosis.
Purpose of the Study:
- To investigate the clinical characteristics and long-term prognosis of patients diagnosed with MPGN.
- To compare the outcomes of C3G and IC-MPGN subtypes.
Main Methods:
- A retrospective analysis of 620 MPGN patients (570 IC-MPGN, 50 C3G) from 18 hospitals (1979-2018).
- Data collected included estimated glomerular filtration rate (eGFR), proteinuria, serum C3 levels, hepatitis B surface antigen status, histological findings, and progression to end-stage kidney disease (ESKD).
Main Results:
- C3G patients presented with lower initial eGFR (49.9 vs. 62.7 mL/min/1.73 m2) but less proteinuria (2.9 vs. 4.7 g/g) compared to IC-MPGN.
- Lower serum C3 levels were observed in C3G, while IC-MPGN showed higher rates of hepatitis B positivity and more chronic histological damage.
- Despite initial differences, the adjusted risk for eGFR decline, ESKD, and mortality was similar between C3G and IC-MPGN over a median follow-up of 122.4 months.
Conclusions:
- C3G is associated with initial severe renal dysfunction but demonstrates long-term renal outcomes comparable to IC-MPGN.
- The findings suggest that C3G, despite potentially fewer chronic histological changes, warrants careful monitoring and management due to its unfavorable long-term prognosis.
