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C3 glomerulopathy and atypical hemolytic uremic syndrome: an updated review of the literature on alternative complement pathway disorders

  • Nephrology - Review
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Abstract

The complement system plays a significant role within the pathological process of C3 glomerulopathy (C3GP) and atypical hemolytic uremic syndrome (aHUS). In daily practice, clinicians should differentiate the subgroups of C3GP because of they should apply different treatment modalities. In the past, C3GP was considered as a part of membranoproliferative glomerulonephritis (MPGN). MPGN is defined as glomerular capillary thickening secondary to the synthesis of the new glomerular basement membrane and mesangial cellular hyperplasia with mesangial matrix expansion. Atypical hemolytic uremic syndrome is an ultra-rare disease that can be outlined by the triad of Coombs negative microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Recent advances demonstrated that these diseases share common abnormalities of the control of the alternative complement system. Therefore, nowadays, most researchers advocate that there may be overlap in the pathogenesis of C3GP and aHUS. This review will provide recent novel mechanisms and treatment options in these diseases. For the purposes that we mentioned above and to help clinicians, we aimed to describe the etiology, pathophysiology, and treatment of C3GP and aHUS in this comprehensive review.

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References

  1. Pickering MC, D’Agati VD, Nester CM, Smith RJ, Haas M, Appel GB, Alpers CE, Bajema IM, Bedrosian C, Braun M, Doyle M, Fakhouri F, Fervenza FC, Fogo AB, Fremeaux-Bacchi V, Gale DP, Goicoechea de Jorge E, Griffin G, Harris CL, Holers VM, Johnson S, Lavin PJ, Medjeral-Thomas N, Paul Morgan B, Nast CC, Noel LH, Peters DK, Rodriguez de Cordoba S, Servais A, Sethi S, Song WC, Tamburini P, Thurman JM, Zavros M, Cook HT (2013) C3 glomerulopathy: consensus report. Kidney Int 84(6):1079–1089. https://doi.org/10.1038/ki.2013.377

    Article  PubMed  PubMed Central  Google Scholar 

  2. Goodship TH, Cook HT, Fakhouri F, Fervenza FC, Fremeaux-Bacchi V, Kavanagh D, Nester CM, Noris M, Pickering MC, Rodriguez de Cordoba S, Roumenina LT, Sethi S, Smith RJ, Conference P (2017) Atypical hemolytic uremic syndrome and C3 glomerulopathy: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. Kidney Int 91(3):539–551. https://doi.org/10.1016/j.kint.2016.10.005

    Article  CAS  PubMed  Google Scholar 

  3. Catikkas M, Demir E, Ozluk Y, Caliskan Y, Badur RM, Turkmen A (2018) Case report: C3 glomerulopathy advancing atypical hemolytic uremic syndrome. Nefrologia 38(4):450–452. https://doi.org/10.1016/j.nefro.2017.09.010

    Article  PubMed  Google Scholar 

  4. Cook HT (2018) Evolving complexity of complement-related diseases: C3 glomerulopathy and atypical haemolytic uremic syndrome. Curr Opin Nephrol Hypertens 27(3):165–170. https://doi.org/10.1097/MNH.0000000000000412

    Article  CAS  PubMed  Google Scholar 

  5. Fervenza FC, Sethi S, Glassock RJ (2012) Idiopathic membranoproliferative glomerulonephritis: does it exist? Nephrol Dial Transplant 27(12):4288–4294. https://doi.org/10.1093/ndt/gfs288

    Article  CAS  PubMed  Google Scholar 

  6. Servais A, Fremeaux-Bacchi V, Lequintrec M, Salomon R, Blouin J, Knebelmann B, Grunfeld JP, Lesavre P, Noel LH, Fakhouri F (2007) Primary glomerulonephritis with isolated C3 deposits: a new entity which shares common genetic risk factors with haemolytic uraemic syndrome. J Med Genet 44(3):193–199. https://doi.org/10.1136/jmg.2006.045328

    Article  CAS  PubMed  Google Scholar 

  7. Sethi S, Nester CM, Smith RJ (2012) Membranoproliferative glomerulonephritis and C3 glomerulopathy: resolving the confusion. Kidney Int 81(5):434–441. https://doi.org/10.1038/ki.2011.399

    Article  PubMed  Google Scholar 

  8. Fakhouri F, Fremeaux-Bacchi V, Noel LH, Cook HT, Pickering MC (2010) C3 glomerulopathy: a new classification. Nat Rev Nephrol 6(8):494–499. https://doi.org/10.1038/nrneph.2010.85

    Article  CAS  PubMed  Google Scholar 

  9. Sethi S, Gamez JD, Vrana JA, Theis JD, Bergen HR 3rd, Zipfel PF, Dogan A, Smith RJ (2009) Glomeruli of dense deposit disease contain components of the alternative and terminal complement pathway. Kidney Int 75(9):952–960. https://doi.org/10.1038/ki.2008.657

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cook HT, Pickering MC (2015) Histopathology of MPGN and C3 glomerulopathies. Nat Rev Nephrol 11(1):14–22. https://doi.org/10.1038/nrneph.2014.217

    Article  CAS  PubMed  Google Scholar 

  11. Sethi S, Zand L, De Vriese AS, Specks U, Vrana JA, Kanwar S, Kurtin P, Theis JD, Angioi A, Cornell L, Fervenza FC (2017) Complement activation in pauci-immune necrotizing and crescentic glomerulonephritis: results of a proteomic analysis. Nephrol Dial Transplant 32(Suppl_1):i139–i145. https://doi.org/10.1093/ndt/gfw299

    Article  CAS  PubMed  Google Scholar 

  12. Sethi S, Fervenza FC, Zhang Y, Zand L, Meyer NC, Borsa N, Nasr SH, Smith RJ (2013) Atypical postinfectious glomerulonephritis is associated with abnormalities in the AP of complement. Kidney Int 83(2):293–299. https://doi.org/10.1038/ki.2012.384

    Article  CAS  PubMed  Google Scholar 

  13. Sethi S, Fervenza FC, Zhang Y, Nasr SH, Leung N, Vrana J, Cramer C, Nester CM, Smith RJ (2011) Proliferative glomerulonephritis secondary to dysfunction of the AP of complement. Clin J Am Soc Nephrol 6(5):1009–1017. https://doi.org/10.2215/CJN.07110810

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zipfel PF, Skerka C, Chen Q, Wiech T, Goodship T, Johnson S, Fremeaux-Bacchi V, Nester C, de Cordoba SR, Noris M, Pickering M, Smith R (2015) The role of complement in C3 glomerulopathy. Mol Immunol 67(1):21–30. https://doi.org/10.1016/j.molimm.2015.03.012

    Article  CAS  PubMed  Google Scholar 

  15. Pickering M, Cook HT (2011) Complement and glomerular disease: new insights. Curr Opin Nephrol Hypertens 20(3):271–277. https://doi.org/10.1097/MNH.0b013e328345848b

    Article  CAS  PubMed  Google Scholar 

  16. Sethi S, Smith RJ, Dillon JJ, Fervenza FC (2015) C3 glomerulonephritis associated with complement factor B mutation. Am J Kidney Dis 65(3):520–521. https://doi.org/10.1053/j.ajkd.2014.10.023

    Article  CAS  PubMed  Google Scholar 

  17. Servais A, Noel LH, Roumenina LT, Le Quintrec M, Ngo S, Dragon-Durey MA, Macher MA, Zuber J, Karras A, Provot F, Moulin B, Grunfeld JP, Niaudet P, Lesavre P, Fremeaux-Bacchi V (2012) Acquired and genetic complement abnormalities play a critical role in dense deposit disease and other C3 glomerulopathies. Kidney Int 82(4):454–464. https://doi.org/10.1038/ki.2012.63

    Article  CAS  PubMed  Google Scholar 

  18. Sethi S, Fervenza FC (2012) Membranoproliferative glomerulonephritis—a new look at an old entity. N Engl J Med 366(12):1119–1131. https://doi.org/10.1056/NEJMra1108178

    Article  CAS  PubMed  Google Scholar 

  19. Noris M, Remuzzi G (2013) Overview of complement activation and regulation. Semin Nephrol 33(6):479–492. https://doi.org/10.1016/j.semnephrol.2013.08.001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Lau KK, Smith RJ, Kolbeck PC, Butani L (2008) Dense deposit disease and the factor H H402 allele. Clin Exp Nephrol 12(3):228–232. https://doi.org/10.1007/s10157-008-0031-z

    Article  PubMed  Google Scholar 

  21. Licht C, Heinen S, Jozsi M, Loschmann I, Saunders RE, Perkins SJ, Waldherr R, Skerka C, Kirschfink M, Hoppe B, Zipfel PF (2006) Deletion of Lys224 in regulatory domain 4 of Factor H reveals a novel pathomechanism for dense deposit disease (MPGN II). Kidney Int 70(1):42–50. https://doi.org/10.1038/sj.ki.5000269

    Article  CAS  PubMed  Google Scholar 

  22. Gale DP, de Jorge EG, Cook HT, Martinez-Barricarte R, Hadjisavvas A, McLean AG, Pusey CD, Pierides A, Kyriacou K, Athanasiou Y, Voskarides K, Deltas C, Palmer A, Fremeaux-Bacchi V, de Cordoba SR, Maxwell PH, Pickering MC (2010) Identification of a mutation in complement factor H-related protein 5 in patients of Cypriot origin with glomerulonephritis. Lancet 376(9743):794–801. https://doi.org/10.1016/S0140-6736(10)60670-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Smith RJH, Appel GB, Blom AM, Cook HT, D’Agati VD, Fakhouri F, Fremeaux-Bacchi V, Jozsi M, Kavanagh D, Lambris JD, Noris M, Pickering MC, Remuzzi G, de Cordoba SR, Sethi S, Van der Vlag J, Zipfel PF, Nester CM (2019) C3 glomerulopathy—understanding a rare complement-driven renal disease. Nat Rev Nephrol 15(3):129–143. https://doi.org/10.1038/s41581-018-0107-2

    Article  PubMed  PubMed Central  Google Scholar 

  24. Servais A, Noel LH, Fremeaux-Bacchi V, Lesavre P (2013) C3 glomerulopathy. Contrib Nephrol 181:185–193. https://doi.org/10.1159/000348654

    Article  PubMed  Google Scholar 

  25. Galbusera M, Noris M, Gastoldi S, Bresin E, Mele C, Breno M, Cuccarolo P, Alberti M, Valoti E, Piras R, Donadelli R, Vivarelli M, Murer L, Pecoraro C, Ferrari E, Perna A, Benigni A, Portalupi V, Remuzzi G (2019) An ex vivo test of complement activation on endothelium for individualized eculizumab therapy in hemolytic uremic syndrome. Am J Kidney Dis 74(1):56–72. https://doi.org/10.1053/j.ajkd.2018.11.012

    Article  CAS  PubMed  Google Scholar 

  26. Arikan H, Koc M, Cakalagaoglu F, Eren Z, Segal MS, Tuglular S, Ozener C, Akoglu E (2008) Tacrolimus rescue therapy in resistant or relapsing cases of primary glomerulonephritis. J Nephrol 21(5):713–721

    CAS  PubMed  Google Scholar 

  27. Rabasco C, Cavero T, Roman E, Rojas-Rivera J, Olea T, Espinosa M, Cabello V, Fernandez-Juarez G, Gonzalez F, Avila A, Baltar JM, Diaz M, Alegre R, Elias S, Anton M, Frutos MA, Pobes A, Blasco M, Martin F, Bernis C, Macias M, Barroso S, de Lorenzo A, Ariceta G, Lopez-Mendoza M, Rivas B, Lopez-Revuelta K, Campistol JM, Mendizabal S, de Cordoba SR, Praga M, Spanish Group for the Study of Glomerular D (2015) Effectiveness of mycophenolate mofetil in C3 glomerulonephritis. Kidney Int 88(5):1153–1160. https://doi.org/10.1038/ki.2015.227

    Article  CAS  PubMed  Google Scholar 

  28. Ravindran A, Fervenza FC, Smith RJH, De Vriese AS, Sethi S (2018) C3 glomerulopathy: ten years’ experience at Mayo clinic. Mayo Clin Proc 93(8):991–1008. https://doi.org/10.1016/j.mayocp.2018.05.019

    Article  PubMed  Google Scholar 

  29. Caliskan Y, Torun ES, Tiryaki TO, Oruc A, Ozluk Y, Akgul SU, Temurhan S, Oztop N, Kilicaslan I, Sever MS (2017) Immunosuppressive treatment in C3 glomerulopathy: is it really effective? Am J Nephrol 46(2):96–107. https://doi.org/10.1159/000479012

    Article  CAS  PubMed  Google Scholar 

  30. Avasare RS, Canetta PA, Bomback AS, Marasa M, Caliskan Y, Ozluk Y, Li Y, Gharavi AG, Appel GB (2018) Mycophenolate mofetil in combination with steroids for treatment of C3 glomerulopathy: a case series. Clin J Am Soc Nephrol 13(3):406–413. https://doi.org/10.2215/CJN.09080817

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Chauvet S, Fremeaux-Bacchi V, Petitprez F, Karras A, Daniel L, Burtey S, Choukroun G, Delmas Y, Guerrot D, Francois A, Le Quintrec M, Javaugue V, Ribes D, Vrigneaud L, Arnulf B, Goujon JM, Ronco P, Touchard G, Bridoux F (2017) Treatment of B-cell disorder improves renal outcome of patients with monoclonal gammopathy-associated C3 glomerulopathy. Blood 129(11):1437–1447. https://doi.org/10.1182/blood-2016-08-737163

    Article  CAS  PubMed  Google Scholar 

  32. Le Quintrec M, Lapeyraque AL, Lionet A, Sellier-Leclerc AL, Delmas Y, Baudouin V, Daugas E, Decramer S, Tricot L, Cailliez M, Dubot P, Servais A, Mourey-Epron C, Pourcine F, Loirat C, Fremeaux-Bacchi V, Fakhouri F (2018) Patterns of clinical response to eculizumab in patients with C3 glomerulopathy. Am J Kidney Dis 72(1):84–92. https://doi.org/10.1053/j.ajkd.2017.11.019

    Article  CAS  PubMed  Google Scholar 

  33. Bomback AS, Smith RJ, Barile GR, Zhang Y, Heher EC, Herlitz L, Stokes MB, Markowitz GS, D’Agati VD, Canetta PA, Radhakrishnan J, Appel GB (2012) Eculizumab for dense deposit disease and C3 glomerulonephritis. Clin J Am Soc Nephrol 7(5):748–756. https://doi.org/10.2215/CJN.12901211

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Le Quintrec M, Lionet A, Kandel C, Bourdon F, Gnemmi V, Colombat M, Goujon JM, Fremeaux-Bacchi V, Fakhouri F (2015) Eculizumab for treatment of rapidly progressive C3 glomerulopathy. Am J Kidney Dis 65(3):484–489. https://doi.org/10.1053/j.ajkd.2014.09.025

    Article  CAS  PubMed  Google Scholar 

  35. Bomback AS (2014) Eculizumab in the treatment of membranoproliferative glomerulonephritis. Nephron Clin Pract 128(3–4):270–276. https://doi.org/10.1159/000368592

    Article  CAS  PubMed  Google Scholar 

  36. Noris M, Remuzzi G (2015) Glomerular diseases dependent on complement activation, including atypical hemolytic uremic syndrome, membranoproliferative glomerulonephritis, and C3 glomerulopathy: core curriculum 2015. Am J Kidney Dis 66(2):359–375. https://doi.org/10.1053/j.ajkd.2015.03.040

    Article  PubMed  PubMed Central  Google Scholar 

  37. Walle JV, Delmas Y, Ardissino G, Wang J, Kincaid JF, Haller H (2017) Improved renal recovery in patients with atypical hemolytic uremic syndrome following rapid initiation of eculizumab treatment. J Nephrol 30(1):127–134. https://doi.org/10.1007/s40620-016-0288-3

    Article  PubMed  Google Scholar 

  38. Fakhouri F, Hourmant M, Campistol JM, Cataland SR, Espinosa M, Gaber AO, Menne J, Minetti EE, Provot F, Rondeau E, Ruggenenti P, Weekers LE, Ogawa M, Bedrosian CL, Legendre CM (2016) Terminal complement inhibitor eculizumab in adult patients with atypical hemolytic uremic syndrome: a single-arm. Open-Label Trial Am J Kidney Dis 68(1):84–93. https://doi.org/10.1053/j.ajkd.2015.12.034

    Article  CAS  PubMed  Google Scholar 

  39. Cofiell R, Kukreja A, Bedard K, Yan Y, Mickle AP, Ogawa M, Bedrosian CL, Faas SJ (2015) Eculizumab reduces complement activation, inflammation, endothelial damage, thrombosis, and renal injury markers in aHUS. Blood 125(21):3253–3262. https://doi.org/10.1182/blood-2014-09-600411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Levi C, Fremeaux-Bacchi V, Zuber J, Rabant M, Devriese M, Snanoudj R, Scemla A, Amrouche L, Mejean A, Legendre C, Sberro-Soussan R (2017) Midterm Outcomes of 12 renal transplant recipients treated with eculizumab to prevent atypical hemolytic syndrome recurrence. Transplantation 101(12):2924–2930. https://doi.org/10.1097/TP.0000000000001909

    Article  CAS  PubMed  Google Scholar 

  41. Cavero T, Rabasco C, Lopez A, Roman E, Avila A, Sevillano A, Huerta A, Rojas-Rivera J, Fuentes C, Blasco M, Jarque A, Garcia A, Mendizabal S, Gavela E, Macia M, Quintana LF, Maria Romera A, Borrego J, Arjona E, Espinosa M, Portoles J, Gracia-Iguacel C, Gonzalez-Parra E, Aljama P, Morales E, Cao M, Rodriguez de Cordoba S, Praga M (2017) Eculizumab in secondary atypical haemolytic uraemic syndrome. Nephrol Dial Transplant 32(3):466–474. https://doi.org/10.1093/ndt/gfw453

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Menne J, Delmas Y, Fakhouri F, Licht C, Lommele A, Minetti EE, Provot F, Rondeau E, Sheerin NS, Wang J, Weekers LE, Greenbaum LA (2019) Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study. BMC Nephrol 20(1):125. https://doi.org/10.1186/s12882-019-1314-1

    Article  PubMed  PubMed Central  Google Scholar 

  43. Martinez-Barricarte R, Heurich M, Valdes-Canedo F, Vazquez-Martul E, Torreira E, Montes T, Tortajada A, Pinto S, Lopez-Trascasa M, Morgan BP, Llorca O, Harris CL, Rodriguez de Cordoba S (2010) Human C3 mutation reveals a mechanism of dense deposit disease pathogenesis and provides insights into complement activation and regulation. J Clin Invest 120(10):3702–3712. https://doi.org/10.1172/JCI43343

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Ardissino G, Testa S, Possenti I, Tel F, Paglialonga F, Salardi S, Tedeschi S, Belingheri M, Cugno M (2014) Discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome: a report of 10 cases. Am J Kidney Dis 64(4):633–637. https://doi.org/10.1053/j.ajkd.2014.01.434

    Article  CAS  PubMed  Google Scholar 

  45. Ardissino G, Possenti I, Tel F (2015) In reply to “discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome.” Am J Kidney Dis 65(2):342–343. https://doi.org/10.1053/j.ajkd.2014.05.028

    Article  PubMed  Google Scholar 

  46. Habbig S, Bergmann C, Weber LT (2016) Discontinuation of Eculizumab in a patient with atypical hemolytic uremic syndrome due to a mutation in CFH. Am J Kidney Dis 67(3):532–533. https://doi.org/10.1053/j.ajkd.2015.11.009

    Article  PubMed  Google Scholar 

  47. Nasr SH, Valeri AM, Appel GB, Sherwinter J, Stokes MB, Said SM, Markowitz GS, D’Agati VD (2009) Dense deposit disease: clinicopathologic study of 32 pediatric and adult patients. Clin J Am Soc Nephrol 4(1):22–32. https://doi.org/10.2215/CJN.03480708

    Article  PubMed  PubMed Central  Google Scholar 

  48. Medjeral-Thomas NR, O’Shaughnessy MM, O’Regan JA, Traynor C, Flanagan M, Wong L, Teoh CW, Awan A, Waldron M, Cairns T, O’Kelly P, Dorman AM, Pickering MC, Conlon PJ, Cook HT (2014) C3 glomerulopathy: clinicopathologic features and predictors of outcome. Clin J Am Soc Nephrol 9(1):46–53. https://doi.org/10.2215/CJN.04700513

    Article  CAS  PubMed  Google Scholar 

  49. Bomback AS, Santoriello D, Avasare RS, Regunathan-Shenk R, Canetta PA, Ahn W, Radhakrishnan J, Marasa M, Rosenstiel PE, Herlitz LC, Markowitz GS, D’Agati VD, Appel GB (2018) C3 glomerulonephritis and dense deposit disease share a similar disease course in a large United States cohort of patients with C3 glomerulopathy. Kidney Int 93(4):977–985. https://doi.org/10.1016/j.kint.2017.10.022

    Article  PubMed  Google Scholar 

  50. Ruebner RL, Kaplan BS, Copelovitch L (2012) A time for reappraisal of “atypical” hemolytic uremic syndrome: should all patients be treated the same? Eur J Pediatr 171(10):1519–1525. https://doi.org/10.1007/s00431-012-1763-z

    Article  PubMed  Google Scholar 

  51. Kaplan BS, Ruebner RL, Spinale JM, Copelovitch L (2014) Current treatment of atypical hemolytic uremic syndrome. Intract Rare Dis Res 3(2):34–45. https://doi.org/10.5582/irdr.2014.01001

    Article  Google Scholar 

  52. Regunathan-Shenk R, Avasare RS, Ahn W, Canetta PA, Cohen DJ, Appel GB, Bomback AS (2019) Kidney Transplantation in C3 glomerulopathy: a case series. Am J Kidney Dis 73(3):316–323. https://doi.org/10.1053/j.ajkd.2018.09.002

    Article  PubMed  Google Scholar 

  53. Kavanagh D, Richards A, Goodship T, Jalanko H (2010) Transplantation in atypical hemolytic uremic syndrome. Semin Thromb Hemost 36(6):653–659. https://doi.org/10.1055/s-0030-1262887

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank for the assistance in English editing, provided by Anna H Moosuddee of Global Editing Service, UK which was funded by Alexion Pharma Turkey.

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  1. Department of Nephrology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey

    Kultigin Turkmen, Ismail Baloglu & Hakan Ozer

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Prof Turkmen received hononarium fee from Alexion Pharma.

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Turkmen, K., Baloglu, I. & Ozer, H. C3 glomerulopathy and atypical hemolytic uremic syndrome: an updated review of the literature on alternative complement pathway disorders. Int Urol Nephrol 53, 2067–2080 (2021). https://doi.org/10.1007/s11255-020-02729-y

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