Semin Thromb Hemost 2014; 40(04): 465-471
DOI: 10.1055/s-0034-1376334
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

C3 Glomerulopathy: The Genetic and Clinical Findings in Dense Deposit Disease and C3 Glomerulonephritis

Xue Xiao
1   Interdisciplinary PhD Program in Genetics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
2   Molecular Otolaryngology and Renal Research Laboratories, Carver College of Medicine, University of Iowa, Iowa City, Iowa
,
Matthew C. Pickering
3   Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
,
Richard J. H. Smith
1   Interdisciplinary PhD Program in Genetics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
2   Molecular Otolaryngology and Renal Research Laboratories, Carver College of Medicine, University of Iowa, Iowa City, Iowa
› Author Affiliations
Further Information

Publication History

Publication Date:
05 May 2014 (online)

Abstract

C3 glomerulopathy (C3G) defines a group of very rare renal diseases in which dysregulation of the alternative and terminal complement pathways plays a pivotal pathogenic role. Dysregulation is driven by genetic and/or acquired defects, with interindividual variability giving rise to two broad subtypes of C3G—dense deposit disease (DDD) and C3 glomerulonephritis (C3GN). Patient evaluation should include genetic testing and biomarker profiling of complement activity. There is currently no effective targeted treatment option for C3G and, as a consequence, a variety of supportive measures are used. C3G remains an ideal disease in which new complement therapies can be tested as they become available. Trials must include a comprehensive evaluation of each patient at the genetic and biomarker level so that individual responses to therapy can be predicted and understood in light of the degree of complement dysregulation and underlying pathology.

 
  • References

  • 1 Hou J, Markowitz GS, Bomback AS , et al. Toward a working definition of C3 glomerulopathy by immunofluorescence. Kidney Int 2014; 85 (2) 450-456
  • 2 Sethi S, Fervenza FC. Pathology of renal diseases associated with dysfunction of the alternative pathway of complement: C3 glomerulopathy and atypical hemolytic uremic syndrome (aHUS). Semin Thromb Hemost 2014; 40 (4) 416-421
  • 3 Servais A, Noël LH, Frémeaux-Bacchi V, Lesavre P. C3 glomerulopathy. Contrib Nephrol 2013; 181: 185-193
  • 4 Medjeral-Thomas NR, O'Shaughnessy MM, O'Regan JA , et al. C3 glomerulopathy: clinicopathologic features and predictors of outcome. Clin J Am Soc Nephrol 2014; 9 (1) 46-53
  • 5 Lu DF, Moon M, Lanning LD, McCarthy AM, Smith RJ. Clinical features and outcomes of 98 children and adults with dense deposit disease. Pediatr Nephrol 2012; 27 (5) 773-781
  • 6 Sethi S, Fervenza FC, Zhang Y , et al. C3 glomerulonephritis: clinicopathological findings, complement abnormalities, glomerular proteomic profile, treatment, and follow-up. Kidney Int 2012; 82 (4) 465-473
  • 7 Barbour TD, Pickering MC, Cook HT. Recent insights into C3 glomerulopathy. Nephrol Dial Transplant 2013; 28 (7) 1685-1693
  • 8 Servais A, Noël LH, Roumenina LT , et al. Acquired and genetic complement abnormalities play a critical role in dense deposit disease and other C3 glomerulopathies. Kidney Int 2012; 82 (4) 454-464
  • 9 Gale DP, de Jorge EG, Cook HT , et al. Identification of a mutation in complement factor H-related protein 5 in patients of Cypriot origin with glomerulonephritis. Lancet 2010; 376 (9743) 794-801
  • 10 Athanasiou Y, Voskarides K, Gale DP , et al. Familial C3 glomerulopathy associated with CFHR5 mutations: clinical characteristics of 91 patients in 16 pedigrees. Clin J Am Soc Nephrol 2011; 6 (6) 1436-1446
  • 11 Martínez-Barricarte R, Heurich M, Valdes-Cañedo F , et al. Human C3 mutation reveals a mechanism of dense deposit disease pathogenesis and provides insights into complement activation and regulation. J Clin Invest 2010; 120 (10) 3702-3712
  • 12 Sethi S, Gamez JD, Vrana JA , et al. Glomeruli of dense deposit disease contain components of the alternative and terminal complement pathway. Kidney Int 2009; 75 (9) 952-960
  • 13 Sethi S, Fervenza FC, Zhang Y , et al. Proliferative glomerulonephritis secondary to dysfunction of the alternative pathway of complement. Clin J Am Soc Nephrol 2011; 6 (5) 1009-1017
  • 14 Mayilyan KR. Complement genetics, deficiencies, and disease associations. Protein Cell 2012; 3 (7) 487-496
  • 15 Smith RJ, Harris CL, Pickering MC. Dense deposit disease. Mol Immunol 2011; 48 (14) 1604-1610
  • 16 Zipfel PF, Skerka C. Complement regulators and inhibitory proteins. Nat Rev Immunol 2009; 9 (10) 729-740
  • 17 Malik TH, Lavin PJ, Goicoechea de Jorge E , et al. A hybrid CFHR3-1 gene causes familial C3 glomerulopathy. J Am Soc Nephrol 2012; 23 (7) 1155-1160
  • 18 Tortajada A, Yébenes H, Abarrategui-Garrido C , et al. C3 glomerulopathy-associated CFHR1 mutation alters FHR oligomerization and complement regulation. J Clin Invest 2013; 123 (6) 2434-2446
  • 19 Medjeral-Thomas N, Malik TH, Patel MP , et al. A novel CFHR5 fusion protein causes C3 glomerulopathy in a family without Cypriot ancestry. Kidney Int 2014; 85 (4) 933-937
  • 20 Chen Q, Wiesener M, Eberhardt H , et al. A novel hybrid CFHR2/CFHR5 gene develops MPGN II and provides insights into disease mechanism and therapeutic implications. Immunobiology 2012; 217 (11) 1131-1132
  • 21 Goicoechea de Jorge E, Caesar JJ, Malik TH , et al. Dimerization of complement factor H-related proteins modulates complement activation in vivo. Proc Natl Acad Sci USA 2013; 110 (12) 4685-4690
  • 22 Skerka C, Chen Q, Fremeaux-Bacchi V, Roumenina LT. Complement factor H related proteins (CFHRs). Mol Immunol 2013; 56 (3) 170-180
  • 23 Boyer O, Noël LH, Balzamo E , et al. Complement factor H deficiency and posttransplantation glomerulonephritis with isolated C3 deposits. Am J Kidney Dis 2008; 51 (4) 671-677
  • 24 Servais A, Noël LH, Dragon-Durey MA , et al. Heterogeneous pattern of renal disease associated with homozygous factor H deficiency. Hum Pathol 2011; 42 (9) 1305-1311
  • 25 Abrera-Abeleda MA, Nishimura C, Frees K , et al. Allelic variants of complement genes associated with dense deposit disease. J Am Soc Nephrol 2011; 22 (8) 1551-1559
  • 26 Westra D, van der Deure J, Volokhina EB, van den Heuvel LPWJ, van de Kar NCAJ. Several genetic aberrations in different complement genes in a patient with dense deposit disease. Mol Immunol 2011; 48 (14) 1682
  • 27 Zhang Y, Meyer NC, Wang K , et al. Causes of alternative pathway dysregulation in dense deposit disease. Clin J Am Soc Nephrol 2012; 7 (2) 265-274
  • 28 de Jorge EG, Gale DP, Cook HT , et al. A mutant complement factor H-related 5 protein is associated with familial C3 glomerulonephritis. Mol Immunol 2009; 46 (14) 2822
  • 29 Servais A, Frémeaux-Bacchi V, Lequintrec M , et al. Primary glomerulonephritis with isolated C3 deposits: a new entity which shares common genetic risk factors with haemolytic uraemic syndrome. J Med Genet 2007; 44 (3) 193-199
  • 30 Human Gene Mutation Database (HGMD). Available at: http://www.hgmd.org/ ; Accessed December 9, 2013
  • 31 Chen Q, Müller D, Rudolph B , et al. Combined C3b and factor B autoantibodies and MPGN type II. N Engl J Med 2011; 365 (24) 2340-2342
  • 32 Strobel S, Zimmering M, Papp K, Prechl J, Józsi M. Anti-factor B autoantibody in dense deposit disease. Mol Immunol 2010; 47 (7–8) 1476-1483
  • 33 Goodship TH, Pappworth IY, Toth T , et al. Factor H autoantibodies in membranoproliferative glomerulonephritis. Mol Immunol 2012; 52 (3–4) 200-206
  • 34 Pickering MC, D'Agati VD, Nester CM , et al. C3 glomerulopathy: consensus report. Kidney Int 2013; 84 (6) 1079-1089
  • 35 Banks RA, May S, Wallington T. Acute renal failure in dense deposit disease: recovery after plasmapheresis. Br Med J (Clin Res Ed) 1982; 284 (6332) 1874-1875
  • 36 Krmar RT, Holtbäck U, Linné T , et al. Acute renal failure in dense deposit disease: complete recovery after combination therapy with immunosuppressant and plasma exchange. Clin Nephrol 2011; 75 (Suppl. 01) 4-10
  • 37 McCaughan JA, O'Rourke DM, Courtney AE. Recurrent dense deposit disease after renal transplantation: an emerging role for complementary therapies. Am J Transplant 2012; 12 (4) 1046-1051
  • 38 Gurkan S, Fyfe B, Weiss L, Xiao X, Zhang Y, Smith RJ. Eculizumab and recurrent C3 glomerulonephritis. Pediatr Nephrol 2013; 28 (10) 1975-1981
  • 39 Riedl M, Fakhouri F, Le Quintrec M , et al. Spectrum of complement-mediated thrombotic microangiopathies: pathogenetic insights identifying novel treatment approaches. Semin Thromb Hemost 2014; 40 (4) 444-464
  • 40 Herlitz LC, Bomback AS, Markowitz GS , et al. Pathology after eculizumab in dense deposit disease and C3 GN. J Am Soc Nephrol 2012; 23 (7) 1229-1237
  • 41 Bomback AS, Smith RJ, Barile GR , et al. Eculizumab for dense deposit disease and C3 glomerulonephritis. Clin J Am Soc Nephrol 2012; 7 (5) 748-756