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Complement System Inhibitors in Nephrology: An Update-Narrative Review.

Mugurel Apetrii1,2, Alexandru Dan Costache1,3, Irina Iuliana Costache Enache1,4

  • 1Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.

International Journal of Molecular Sciences
|June 26, 2025
PubMed
Summary

Complement inhibitors show promise in treating kidney diseases driven by complement dysregulation. They are most effective in C3 glomerulopathy, atypical hemolytic uremic syndrome, and IC-MPGN, offering targeted treatment strategies.

Keywords:
C3 glomerulopathyatypical hemolytic uremic syndromecomplement systemimmune complex membranoproliferative glomerulonephritis

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Area of Science:

  • Nephrology
  • Immunology
  • Pharmacology

Background:

  • Complement dysregulation is a key factor in the pathogenesis of various kidney diseases.
  • Understanding the complement system's role is crucial for developing targeted therapies.

Purpose of the Study:

  • To review the role of complement activation in nephrological diseases.
  • To summarize evidence for complement inhibitors as therapeutic agents in kidney disorders.

Main Methods:

  • Literature review of studies on complement activation in kidney diseases.
  • Analysis of clinical trial data for complement inhibitors in nephrology.

Main Results:

  • Complement inhibitors are highly effective in C3 glomerulopathy (C3G), atypical hemolytic uremic syndrome (aHUS), and immune complex membranoproliferative glomerulonephritis (IC-MPGN).
  • Variable benefits are observed in lupus nephritis and ANCA-associated vasculitis.
  • Limited efficacy is noted in diabetic nephropathy and focal-segmental glomerulosclerosis.

Conclusions:

  • Complement inhibition provides a targeted approach to manage and potentially halt the progression of specific nephrological conditions.
  • Therapeutic success is linked to the degree of complement system involvement in disease pathogenesis.