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Kidney Week

Abstract: FR-PO721

Looks Can Be Deceiving: A Case of C3 Glomerulopathy

Session Information

Category: Glomerular Diseases

  • 1401 Glomerular Diseases: From Inflammation to Fibrosis

Authors

  • Dao, Kevin, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
  • Edwin, Robin, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
  • Mirza, Mohid, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
  • Macneil, Richard Gavin, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
  • Mikhailov, Alexei V., Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
  • Daeihagh, Pirouz, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
Introduction

Complement 3 glomerulopathy (C3G) is caused by an acquired or genetic dysregulation of the complement alternative pathway. It can be further classified into dense deposit disease (DDD) or C3 glomerulonephritis (C3GN). We present a case of a middle age male who presented with suspected infection-related glomerulonephritis (IRGN). However, his renal functions did not significantly improve with antibiotics. Renal biopsy was performed and he was diagnosed with C3GN.

Case Description

55-year-old male with past medical history of untreated hepatitis C and former intravenous drug use presented for evaluation of oliguric acute kidney injury, hematuria, and rash in the setting of MSSA empyema and chest wall osteomyelitis. He was septic and had acute renal failure requiring broad spectrum antibiotics and renal replacement therapy. Further GN work up was significant for proteinuria 11g/g, elevated Anti-DNASE, cryoglobulins 1.0%, undetectable C3, low C4 and M spike on SPEP. Patient was treated with prolonged course of antibiotics for presumed endocarditis. Differential included IRGN but due to multiple abnormal serological markers a renal biopsy was performed which revealed C3GN. He was started on steroid taper and mycophenolate mofetil with rapid improvement in edema and renal functions. Dialysis was discontinued and patient was discharged on immunosuppressive therapy.

Discussion

C3G is a difficult diagnosis and may often require immunosuppression (IS). Our patient above was requiring routine dialysis until the initation of IS and was able to stop dialysis shortly after. Patients who are suspected to have IRGN that are not improving with antibiotics should have C3GN included in the differential. Biopsy is warranted in these patients and IS may help with improving outcomes.

Diffuse global crescents on LM(A). Fibrinoid necrosis on LM(B). Mesangial subendothelial dense deposits (arrow) on EM(C). C3 4+ on glomerular capillary walls on IF(D).