Abstract: SA-PO0689
Tonsillectomy-Associated Remission of C3 Glomerulonephritis: A Mucosal-Complement Link?
Session Information
- Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Alhakamy, Mohammad Abdallah Y, Aseer Central Hospital, Abha, Aseer Province, Saudi Arabia
- Asiri, Abdullah, Aseer Central Hospital, Abha, Aseer Province, Saudi Arabia
- Alsaad, Khaled O., King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh Province, Saudi Arabia
- Alshehri, Mohammed, King Khalid University College of Medicine, Abha, Aseer Province, Saudi Arabia
Introduction
C3 glomerulopathy (C3G) is a rare complement-mediated disease driven by dysregulation of the alternative pathway. Although genetic and acquired abnormalities are well described, the contribution of environmental triggers to disease activity remains unclear. Upper respiratory tract infections (URTI) may precipitate flares, but interventions targeting mucosal immune activation remain unestablished.
Case Description
A 15-year-old presented with a history of recurrent gross hematuria temporally associated with episodes of tonsillitis. Urinalysis showed hematuria (31–50 RBCs/HPF, blood +++) and proteinuria (24-hour protein 1.18 g/day). Creatinine was normal at 0.7 mg/dL. Serologic workup, including ANA, ANCA, and anti-GBM antibodies, was negative. Complement testing showed low-normal C3 with preserved C4.Kidney biopsy demonstrated C3-dominant glomerular staining (3+). EM showed mesangial and subendothelial dense deposits without subepithelial humps, consistent with C3 GN. Genetic testing for complement-mediated disorders was negative.The patient received transient RAAS blockade without immunosuppressive therapy. Given recurrent tonsillitis, tonsillectomy was performed. Thereafter, hematuria and proteinuria resolved, with stable renal function. He was followed for 1 year after tonsillectomy with no relapse.
Discussion
This case suggests a link between mucosal immune activation and complement-mediated glomerular injury. URTI-triggered flares followed by complete remission after tonsillectomy support a trigger-dependent mechanism. Although causality cannot be proven from one case, it highlights a possible mucosal–complement axis in C3G and suggests tonsillectomy may be a potential intervention in selected similar cases.
Renal biopsy showing C3 glomerulonephritis: mild proliferative changes on PAS, C3-dominant staining on IF, and electron-dense deposits on EM.