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Serum complement levels before and after the onset of acute post-streptococcal glomerulonephritis. A case report
C F Strife1, T J Forristal, J Forristal
1Division of Nephrology, Children's Hospital Medical Center, Cincinnati, Ohio 45229-2899.
Insights
Complement activation, particularly via the alternative pathway, appears to precede the clinical onset of acute post-streptococcal glomerulonephritis (APSGN). This early activation involves specific complement components before nephritis symptoms manifest.
Area of Science:
- Immunology
- Nephrology
- Pediatrics
Background:
- Acute post-streptococcal glomerulonephritis (APSGN) is a common renal disease in children.
- Low serum levels of complement components C3, C5, and properdin are characteristic of the acute phase of APSGN, indicating significant complement system activation.
- The specific timing and predominant pathway of complement activation in relation to clinical APSGN onset remain areas of investigation.
Observation:
- A case study of a child hospitalized with erysipelas who subsequently developed APSGN was monitored.
- Serum samples were analyzed for complement component levels before and after the clinical onset of nephritis.
- Initial serum samples, taken before nephritis symptoms, showed low properdin levels and normal C3/C5, despite detectable C3 splitting activity.
Findings:
- The patient exhibited low serum C3, properdin, and C5 levels after the clinical onset of gross hematuria, consistent with typical APSGN.
- Early complement activation, evidenced by low properdin and C3 splitting activity, was detected prior to the overt clinical presentation of APSGN.
- Complement activation, predominantly via the alternative pathway, appears to initiate before the development of clinical nephritis.
Implications:
- These findings suggest that complement activation is an early event in the pathogenesis of APSGN.
- Understanding the temporal sequence of complement activation may offer insights into potential early diagnostic markers for APSGN.
- Targeting the alternative complement pathway could be a future therapeutic strategy for preventing or mitigating APSGN.
Abstract:
Low serum C3, properdin, and C5 levels found in the acute stage of acute post-streptococcal glomerulonephritis (APSGN) indicate the presence of aggressive complement activation. We followed serum complement component levels in a child hospitalized with erysipelas who developed APSGN on the 2nd hospital day. Her initial serum sample, obtained prior to the clinical onset of nephritis, had a low properdin level and normal C3 and C5 levels despite the presence of C3 splitting activity. Two days later she developed gross hematuria and subsequent sera contained low C3, properdin, and C5 levels, as is usual in APSGN. These observations suggest that complement activation, predominantly through the alternative pathway, precedes the clinical onset of APSGN.