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Abstract: FR-PO899

Outcome of Membranoproliferative Glomerulonephritis and Postinfectious Glomerulonephritis Stratified by New Classification

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Oh, Sewon, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Son, Young-Bin, Korea university, Seoul, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seong nam, Korea (the Republic of)
  • Lee, Kyungmi, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Lim, Kijoon, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Yang, Jihyun, Korea university medical college, Seoul, South Africa
  • Kim, Myung-Gyu, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Jo, Sang-Kyung, Korea University Hospital, Seoul, Korea (the Republic of)

Group or Team Name

  • Korea University Anam Hospital, Korea University College of Medicine
Background

The new classification of membranoproliferative glomerulonephritis (MPGN) has been suggested based on the immunofluorescence (IF) staining: Immune complex (IC)-MPGN and C3 glomerulopathy. In addition, the possibility of overlap between C3 glomerulopathy and postinfectious glomerulonephritis (PIGN) has been raised because of high proportion of C3 dominancy and poor renal outcome in PIGN. However, little is known about clinical features and outcomes of C3 glomerulopathy compared to IC mediated GN (IC-GN).

Methods

A total of 4,431 patients who underwent kidney biopsy and had IF data were identified in six university hospitals during 1980-2018. We included 280 subjects with MPGN and 69 with PIGN. C3 dominant glomerulonephritis (C3DG) was defined as C3 staining stronger than immunoglobulins in patients with MPGN or PIGN.

Results

Among patients with MPGN and PIGN, 39 (14%) and 36 (52%) were classified as C3DG. C3DG had higher proportion of women, lower C3, nephrotic range proteinuria and serum cholesterol, and higher serum albumin although renal function was not different at the time of biopsy (P<0.05). In addition, C3DG had almost no association with viral hepatitis B (3.1 vs. 29.2%, P<0.001), and lower tendency of ANA (P=0.085). After 6 months of biopsy, C3DG had significantly lower proteinuria and high rate for remission of proteinuria (P<0.05). The incidence of 40% decline in eGFR was significantly lower in C3DG compared than IC-mediated GN (16.3% vs. 31.5%, P=0.031). The incidence of end stage renal disease (ESRD) was the highest in IC-MPGN and the lowest in C3-PIGN during 107 [28-247] months of median follow up (IC-MPGN, 37.4%; C3-MPGN; 26.3%, IC-PIGN; 22.2%, C3-PIGN, 9.1%; P=0.036). Together with MPGN and PIGN, C3DG was associated with better renal survival (P=0.016). Multivariate analysis showed that C3DG demonstrated 0.396-fold increase of ESRD (95% CI, 0.192-0.814) compared than IC-GN. Mortality was not significant between groups.

Conclusion

C3DG had lower rate of moderate proteinuria and less likely to be associated with chronic infection and autoimmune disease at presentation. The 13.7% of C3DG progressed to ESRD in although it showed favorable renal survival compared to IC-MPGN.