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Kidney Week

Abstract: PO1943

Low Serum C3 at Diagnosis of Pauci-Immune Glomerulonephritis Is Associated with More Advanced Kidney Impairment and Worst Renal Prognosis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Lionaki, Sophia, Nephrology, Laiko Hospital, Athens, Greece
  • Marinaki, Smaragdi, Nephrology, Laiko Hospital, Athens, Greece
  • Kalaitzakis, Emmanuel, Nephrology, Laiko Hospital, Athens, Greece
  • Fragkioudaki, Sofia, Nephrology, Laiko Hospital, Athens, Greece
  • Kalogeropoulos, Petros, Nephrology, Laiko Hospital, Athens, Greece
  • Liapis, Georgios, Pathology, Laiko Hospital, Athens, Greece
  • Tzioufas, Athanasios, Pathophysiology, Laiko Hospital, Athens, Greece
  • Boletis, Ioannis, Nephrology, Laiko Hospital, Athens, Greece
Background

Recent evidence supports the notion that complement activation plays a critical role in pauci-immune (PI) vasculitis pathogenesis. The aim of this study was to investigate if the clinical, serological and laboratory characteristics and treatment outcomes of patients with PI glomerulonephritis (GN) with low serum complement levels at diagnosis differ from those of patients with complement values within the normal range.

Methods

In a retrospective design we studied patients with biopsy proven PIGN with available serum complement measurements at diagnosis, or during a relapse, prior to initiation of immunosuppressive therapy. All patients were tested for antineutrophil cytoplasmic antibodies (ANCA) at presentation. Fisher's exact tests and Wilcoxon rank sum tests were used to compare the characteristics by serum C3.

Results

Of 96 patients included in the study, 22 (22.9%) had low serum C3 at diagnosis. Comparison of clinical, serological and laboratory characteristics and outcomes between the two groups is shown in [table 1].

Conclusion

Almost one quarter of patients with biopsy proven PIGN had low serum C3 at diagnosis in this cohort. These patients had more advanced renal impairment, required acute dialysis more frequently and were more likely to end up in end-stage kidney disease compared to patients with serum C3 within the normal range.

Characteristic

Mean(sd) or Ν(%)
PIGN with low serum C3

Ν=22
PIGN with normal serum C3

Ν=74
p value
Age (years)60.4(±13.1)58.3 (±15.6)0.42
Gender (male)12 (57.1)35 (47.3)0.45
BVAS16.6 (±5.35)17.7 (±5.75)0.89
ANCA type   
P/MPO-ANCA14(63.6)44(59.45)0.71
C/PR3-ANCA6 (27.3)25 (33.8) 
Negative2 (9.1)5 (6.75) 
Clinical phenotype   
Microscopic Polyangiitis11(50)29 (39.2) 
Polyangiitis with Granulomatosis5 (22.7)17 (22.9)0.38
Kidney limited disease6 (27.3)28 (37.8) 
Serum creatinine (mg/dl)8.25 (±3.8)2.875 (±1.9)<0.0001
Peak serum creatinine (mg/dl)10.8 (±3.3)2.9 (±1.7)<0.0001
Patients requiring acute dialysis10 (±47.6)13 (±17.5)0.004
Outcome   
Remission13(59.1)55(74.2)0.17
ESKD9(40.9)10 (13.6)0.006