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Günay N, Dursun İ, Gökçe İ, Akbalık Kara M, Tekcan D, Çiçek N, Torun Bayram M, Koyun M, Dinçel N, Dursun H, Saygılı S, Yürük Yıldırım ZN, Yüksel S, Dönmez O, Yel S, Demircioğlu Kılıç B, Aydoğ Ö, Atmış B, Çaltık Yılmaz A, Bakkaloğlu SA, Aytaç MB, Taşdemir M, Kasap Demir B, Soylu A, Çomak E, Kantar Özşahin A, Kaçar A, Canpolat N, Yılmaz A, Girişgen İ, Akkoyunlu KB, Alpay H, Poyrazoğlu HM. Complement gene mutations in children with C3 glomerulopathy: do they affect the response to mycophenolate mofetil? Pediatr Nephrol 2024; 39:1435-1446. [PMID: 38041748 DOI: 10.1007/s00467-023-06231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND C3 glomerulopathy (C3G) is a complement-mediated disease. Although genetic studies are not required for diagnosis, they are valuable for treatment planning and prognosis prediction. The aim of this study is to investigate the clinical phenotypes, kidney survival, and response to mycophenolate mofetil (MMF) treatment in pediatric C3G patients with and without mutations in complement-related genes. METHODS Sixty pediatric C3G patients were included, divided into two groups based on complement-related gene mutations. Demographic and clinical-pathological findings, treatment modalities, and outcome data were compared, and Kaplan-Meier analysis was performed for kidney survival. RESULTS Out of the 60 patients, 17 had mutations. The most common mutation was in the CFH gene (47%). The mean age at diagnosis was higher in the group with mutation (12.9 ± 3.6 vs. 11.2 ± 4.1 years, p = 0.039). While the patients without mutation most frequently presented with nephritic syndrome (44.2%), the mutation group was most likely to have asymptomatic urinary abnormalities (47.1%, p = 0.043). Serum parameters and histopathological characteristics were similar, but hypoalbuminemia was more common in patients without mutation. During 45-month follow-up,10 patients progressed to chronic kidney disease stage 5 (CKD5), with 4 having genetic mutation. The time to develop CKD5 was longer in the mutation group but not significant. MMF treatment had no effect on progression in either group. CONCLUSIONS This study is the largest pediatric C3G study examining the relationship between genotype and phenotype. We showed that the mutation group often presented with asymptomatic urinary abnormalities, was diagnosed relatively late but was not different from the without mutation group in terms of MMF treatment response and kidney survival.
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Affiliation(s)
- Neslihan Günay
- Department of Pediatric Nephrology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - İbrahim Gökçe
- Department of Pediatric Nephrology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Mehtap Akbalık Kara
- Department of Pediatric Nephrology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Demet Tekcan
- Department of Pediatric Nephrology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Neslihan Çiçek
- Department of Pediatric Nephrology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Meral Torun Bayram
- Dokuz Eylül University Medical Faculty, Department of Pediatric Nephrology, İzmir, Turkey
| | - Mustafa Koyun
- Department of Pediatric Nephrology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Nida Dinçel
- Behçet Uz Pediatric Diseases Training and Research Hospital, Pediatric Nephrology Clinic, İzmir, Turkey
| | - Hasan Dursun
- Prof. Dr. Cemil, Taşcıoğlu City Hospital Pediatric Nephrology Clinic, Istanbul, Turkey
| | - Seha Saygılı
- Department of Pediatric Nephrology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | | | - Selçuk Yüksel
- Department of Pediatric Nephrology, Pamukkale University Medical Faculty, Denizli, Turkey
| | - Osman Dönmez
- Department of Pediatric Nephrology, Uludağ University Medical Faculty, Bursa, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | | | - Özlem Aydoğ
- Department of Pediatric Nephrology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Bahriye Atmış
- Department of Pediatric Nephrology, Çukurova University Medical Faculty, Adana, Turkey
| | - Aysun Çaltık Yılmaz
- Department of Pediatric Nephrology, Ankara Baskent University, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Nephrology, Gazi University Medical Faculty, Ankara, Turkey
| | - Mehmet Baha Aytaç
- Department of Pediatric Nephrology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Mehmet Taşdemir
- Department of Pediatric Nephrology, İstinye University Medical Faculty, Istanbul, Turkey
| | - Belde Kasap Demir
- Medical Faculty Division of Pediatric Nephrology, İzmir Katip Çelebi University, İzmir, Turkey
| | - Alper Soylu
- Dokuz Eylül University Medical Faculty, Department of Pediatric Nephrology, İzmir, Turkey
| | - Elif Çomak
- Department of Pediatric Nephrology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Aslı Kantar Özşahin
- Behçet Uz Pediatric Diseases Training and Research Hospital, Pediatric Nephrology Clinic, İzmir, Turkey
| | - Alper Kaçar
- Prof. Dr. Cemil, Taşcıoğlu City Hospital Pediatric Nephrology Clinic, Istanbul, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Alev Yılmaz
- İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul University, Istanbul, Turkey
| | - İlknur Girişgen
- Department of Pediatric Nephrology, Pamukkale University Medical Faculty, Denizli, Turkey
| | | | - Harika Alpay
- Department of Pediatric Nephrology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Hakan M Poyrazoğlu
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
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Pınarbaşı AS, Dursun I, Gokce I, Çomak E, Saygılı S, Bayram MT, Donmez O, Melek E, Tekcan D, Çiçek N, Yılmaz D, Tabel Y, Yıldırım ZY, Bahat E, Koyun M, Soylu A, Canpolat N, Aksu B, Çelakıl ME, Taşdemir M, Benzer M, Özçelik G, Bakkaloğlu SA, Düşünsel R. Predictors of poor kidney outcome in children with C3 glomerulopathy. Pediatr Nephrol 2021; 36:1195-1205. [PMID: 33130981 DOI: 10.1007/s00467-020-04799-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/13/2020] [Accepted: 09/24/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND C3 glomerulopathy (C3G) is characterized by heterogeneous clinical presentation, outcome, and predominant C3 accumulation in glomeruli without significant IgG. There is scarce outcome data regarding childhood C3G. We describe clinical and pathological features, treatment and outcomes, and risk factors for progression to chronic kidney disease stage 5 (CKD5) in the largest pediatric series with biopsy-proven C3G. METHODS Sixty pediatric patients with C3G from 21 referral centers in Turkey were included in this retrospective study. Patients were categorized according to CKD stage at last visit as CKD5 or non-CKD5. Demographic data, clinicopathologic findings, treatment, and outcome data were compared and possible risk factors for CKD5 progression determined using Cox proportional hazards model. RESULTS Mean age at diagnosis was 10.6 ± 3.0 years and follow-up time 48.3 ± 36.3 months. Almost half the patients had gross hematuria and hypertension at diagnosis. Nephritic-nephrotic syndrome was the commonest presenting feature (41.6%) and 1/5 of patients presented with nephrotic syndrome. Membranoproliferative glomerulonephritis was the leading injury pattern, while 40 patients had only C3 staining. Patients with DDD had significantly lower baseline serum albumin compared with C3GN. Eighteen patients received eculizumab. Clinical remission was achieved in 68.3%. At last follow-up, 10 patients (16.6%) developed CKD5: they had lower baseline eGFR and albumin and higher frequency of nephrotic syndrome and dialysis requirement than non-CKD5 patients. Lower serum albumin and eGFR at diagnosis were independent predictors for CKD5 development. CONCLUSIONS Children with C3G who have impaired kidney function and hypoalbuminemia at diagnosis should be carefully monitored for risk of progression to CKD5. Graphical abstract.
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Affiliation(s)
- Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ismail Dursun
- Department of Pediatric Nephrology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Ibrahim Gokce
- Department of Pediatric Nephrology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Elif Çomak
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Seha Saygılı
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Meral Torun Bayram
- Department of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Osman Donmez
- Department of Pediatric Nephrology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Engin Melek
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Demet Tekcan
- Department of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Neslihan Çiçek
- Department of Pediatric Nephrology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Dilek Yılmaz
- Department of Pediatric Nephrology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Yılmaz Tabel
- Department of Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Zeynep Y Yıldırım
- Department of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Elif Bahat
- Department of Pediatric Nephrology, Faculty of Medicine, Karadeniz Teknik University, Trabzon, Turkey
| | - Mustafa Koyun
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Alper Soylu
- Department of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Bağdagül Aksu
- Department of Pediatric Nephrology, University of Health Sciences, Haseki Education and Research Hospital, İstanbul, Turkey
| | - Mehtap Ezel Çelakıl
- Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Mehmet Taşdemir
- Department of Pediatric Nephrology, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Meryem Benzer
- Department of Pediatric Nephrology, Bakırköy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Gül Özçelik
- Department of Pediatric Nephrology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ruhan Düşünsel
- Department of Pediatric Nephrology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
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Treatment of C3 Glomerulopathy in Adult Kidney Transplant Recipients: A Systematic Review. Med Sci (Basel) 2020; 8:medsci8040044. [PMID: 33096866 PMCID: PMC7712822 DOI: 10.3390/medsci8040044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND C3 glomerulopathy (C3G), a rare glomerular disease mediated by alternative complement pathway dysregulation, is associated with a high rate of recurrence and graft loss after kidney transplantation (KTx). We aimed to assess the efficacy of different treatments for C3G recurrence after KTx. METHODS Databases (MEDLINE, EMBASE, and Cochrane Database) were searched from inception through 3 May, 2019. Studies were included that reported outcomes of adult KTx recipients with C3G. Effect estimates from individual studies were combined using the random-effects, generic inverse variance method of DerSimonian and Laird., The protocol for this meta-analysis is registered with PROSPERO (no. CRD42019125718). RESULTS Twelve studies (7 cohort studies and 5 case series) consisting of 122 KTx patients with C3G (73 C3 glomerulonephritis (C3GN) and 49 dense deposit disease (DDD)) were included. The pooled estimated rates of allograft loss among KTx patients with C3G were 33% (95% CI: 12-57%) after eculizumab, 42% (95% CI: 2-89%) after therapeutic plasma exchange (TPE), and 81% (95% CI: 50-100%) after rituximab. Subgroup analysis based on type of C3G was performed. Pooled estimated rates of allograft loss in C3GN KTx patients were 22% (95% CI: 5-46%) after eculizumab, 56% (95% CI: 6-100%) after TPE, and 70% (95% CI: 24-100%) after rituximab. Pooled estimated rates of allograft loss in DDD KTx patients were 53% (95% CI: 0-100%) after eculizumab. Data on allograft loss in DDD after TPE (1 case series, 0/2 (0%) allograft loss at 6 months) and rituximab (1 cohort, 3/3 (100%) allograft loss) were limited. Among 66 patients (38 C3GN, 28 DDD) who received no treatment (due to stable allograft function at presentation and/or clinical judgment of physicians), pooled estimated rates of allograft loss were 32% (95% CI: 7-64%) and 53% (95% CI: 28-77%) for C3GN and DDD, respectively. Among treated C3G patients, data on soluble membrane attack complex of complement (sMAC) were limited to patients treated with eculizumab (N = 7). 80% of patients with elevated sMAC before eculizumab responded to treatment. In addition, all patients who responded to eculizumab had normal sMAC levels after post-eculizumab. CONCLUSIONS Our study suggests that the lowest incidence of allograft loss (33%) among KTX patients with C3G are those treated with eculizumab. Among those who received no treatment for C3G due to stable allograft function, there is a high incidence of allograft loss of 32% in C3GN and 53% in DDD. sMAC level may help to select good responders to eculizumab.
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