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Published on: October 11, 2014
Clinical and Pathological Course of Recurrent C3 Glomerulonephritis from Onset to Graft Loss: A Case Report
Azusa Kobayashi1, Asami Takeda2, Shoji Saito1
1Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Insights
Recurrent Complement 3 glomerulonephritis (C3GN) after kidney transplant showed early recurrence but stable activity for 8 years. Chronic allograft dysfunction eventually led to graft failure and dialysis.
Area of Science:
- Nephrology
- Transplantation immunology
Background:
- Complement 3 glomerulonephritis (C3GN) frequently recurs post-kidney transplantation.
- Early diagnosis and understanding of C3GN recurrence are crucial for graft survival.
Purpose of the Study:
- To report a case of recurrent C3GN diagnosed via allograft biopsy.
- To evaluate the long-term clinical and pathological course of recurrent C3GN after transplantation.
Main Methods:
- Case report of a 35-year-old male recipient of a living-donor renal allograft.
- Allograft biopsies performed at 3 weeks, 1 year, and approximately 10 years post-transplantation.
- Clinical data including renal function and urinary protein levels were monitored.
Main Results:
- Recurrent C3GN was diagnosed 3 weeks post-transplantation based on C3 deposits in the allograft.
- The patient maintained stable graft function for 8 years, with minimal C3GN activity.
- After 8 years, progressive chronic allograft dysfunction developed, characterized by secondary FSGS and arteriolopathy, leading to graft failure.
Conclusions:
- C3GN can recur early but remain indolent for years post-transplantation.
- Chronic allograft dysfunction in recurrent C3GN is multifactorial.
- Further studies are needed to establish optimal management strategies and predict prognosis for recurrent C3GN.
Introduction:
Complement 3 glomerulonephritis (C3GN) has a high recurrence rate after kidney transplantation. Before the disease became well understood, kidney transplantation was performed without a diagnosis of C3GN. This report describes a case of recurrent C3GN diagnosed using allograft biopsy and evaluates its long-term clinical and pathological course.
Case Presentation:
A 35-year-old man with membranoproliferative glomerulonephritis underwent an ABO-compatible living-donor renal transplantation. Three weeks post-transplantation, an allograft biopsy showed prominent granular C3 deposits. One year after transplantation, an allograft biopsy revealed slight mesangial expansion with C3 deposits and a few urinary proteins. Recurrent C3GN was diagnosed based on similar C3 deposition in the native kidney. Eight years post-transplantation, urinary protein levels began to increase and renal function gradually declined. Approximately 10 years after transplantation, an allograft biopsy revealed severe secondary focal segmental glomerulosclerosis and arteriolopathy with no active C3GN lesions. Ten months later, deteriorating kidney function necessitated hemodialysis.
Conclusion:
In this case, C3GN recurred early after transplantation, but its activity did not increase for 8 years. The causes of chronic allograft dysfunction vary among cases. More cases and detailed observational studies are needed to determine treatment strategies for recurrent C3GN and graft prognosis.
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