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Long-term evolution of patients with isolated C3 mesangial glomerulonephritis
J Calls Ginesta1, J Almirall, A Torras
1Nephrology Service, Hospital Clínic i Provincial, Barcelona, Spain.
Abstract:
Isolated mesangial C3 proliferative glomerulonephritis is a nephropathy poorly defined among glomerular diseases. Clinical picture is characterized by episodes of gross hematuria and/or persistent or recurrent microhematuria and/or proteinuria. Short-term prognosis (less than 3 years) is considered to be benign, although not much information is available in reference to long-term follow-up. We reviewed all renal biopsies performed in our center between 1978 and 1992 (n = 2,200) in order to study clinical course of these patients. Isolated mesangial C3 deposition was found in 11 cases (0.5%). Isolated proteinuria (> 0.5 g/d) was present in 3 patients and nephrotic syndrome in 2. Hematuria with proteinuria was detected in 5 patients. In one patient hematuria was the only clinical finding. Arterial hypertension was observed in 4 cases. At the time of renal biopsy, renal function was accurately normal in all but one patient. In our series, renal function showed no changes during the first 3 years, accordingly to data referred to in the literature. After 7 years of follow-up, however, renal function was declining in 4 of 5 patients who developed terminal renal failure up to requiring hemodialysis. Therefore, initial benign prognosis ascribed to this glomerulonephritis would not be confirmed in a long-term follow-up.
Insights
Isolated mesangial C3 glomerulonephritis, often considered benign short-term, shows declining renal function in most patients after seven years. Long-term prognosis requires further investigation for this rare kidney disease.
Area of Science:
- Nephrology
- Immunopathology
Background:
- Isolated mesangial C3 glomerulonephritis is an under-characterized glomerular disease.
- Clinical presentation includes hematuria and proteinuria, with a presumed benign short-term prognosis.
Purpose of the Study:
- To investigate the long-term clinical course and prognosis of patients with isolated mesangial C3 glomerulonephritis.
Main Methods:
- Retrospective review of 2,200 renal biopsies from 1978-1992.
- Analysis of clinical findings, renal function, and long-term outcomes in 11 identified cases.
Main Results:
- Eleven cases (0.5%) of isolated mesangial C3 deposition were identified.
- Patients presented with hematuria, proteinuria, or nephrotic syndrome; hypertension was noted in 4 cases.
- While renal function was normal initially, 4 of 5 patients experienced declining function and terminal renal failure within 7 years.
Conclusions:
- The short-term benign prognosis of isolated mesangial C3 glomerulonephritis is not supported by long-term follow-up data.
- This condition can lead to progressive renal impairment and end-stage renal disease, necessitating closer monitoring.