Predictors of poor kidney outcome in children with C3 glomerulopathy

Abstract

Background C3 glomerulopathy (C3G) is characterized by heterogeneous clinical presentation, outcome, and predominant C3 accumulation in glomeruli without significant IgG. There is scarce outcome data regarding childhood C3G. We describe clinical and pathological features, treatment and outcomes, and risk factors for progression to chronic kidney disease stage 5 (CKD5) in the largest pediatric series with biopsy-proven C3G.

Methods Sixty pediatric patients with C3G from 21 referral centers in Turkey were included in this retrospective study. Patients were categorized according to CKD stage at last visit as CKD5 or non-CKD5. Demographic data, clinicopathologic findings, treatment, and outcome data were compared and possible risk factors for CKD5 progression determined using Cox proportional hazards model.

Results Mean age at diagnosis was 10.6 +/- 3.0 years and follow-up time 48.3 +/- 36.3 months. Almost half the patients had gross hematuria and hypertension at diagnosis. Nephritic-nephrotic syndrome was the commonest presenting feature (41.6%) and 1/5 of patients presented with nephrotic syndrome. Membranoproliferative glomerulonephritis was the leading injury pattern, while 40 patients had only C3 staining. Patients with DDD had significantly lower baseline serum albumin compared with C3GN. Eighteen patients received eculizumab. Clinical remission was achieved in 68.3%. At last follow-up, 10 patients (16.6%) developed CKD5: they had lower baseline eGFR and albumin and higher frequency of nephrotic syndrome and dialysis requirement than non-CKD5 patients. Lower serum albumin and eGFR at diagnosis were independent predictors for CKD5 development.

Conclusions Children with C3G who have impaired kidney function and hypoalbuminemia at diagnosis should be carefully monitored for risk of progression to CKD5.

C1 [Pinarbasi, Ayse Seda; Dursun, Ismail; Dusunsel, Ruhan] Erciyes Univ, Dept Pediat Nephrol, Fac Med, Kayseri, Turkey.

[Gokce, Ibrahim; cicek, Neslihan] Marmara Univ, Fac Med, Dept Pediat Nephrol, Istanbul, Turkey.

[comak, Elif; Koyun, Mustafa] Akdeniz Univ, Dept Pediat Nephrol, Fac Med, Antalya, Turkey.

[Saygili, Seha; Canpolat, Nur] Istanbul Univ, Cerrahpasa Fac Med, Dept Pediat Nephrol, Istanbul, Turkey.

[Bayram, Meral Torun; Soylu, Alper] Dokuz Eylul Univ, Dept Pediat Nephrol, Fac Med, Izmir, Turkey.

[Donmez, Osman] Uludag Univ, Dept Pediat Nephrol, Fac Med, Bursa, Turkey.

[Melek, Engin] Cukurova Univ, Dept Pediat Nephrol, Fac Med, Adana, Turkey.

[Tekcan, Demet] Ondokuz Mayis Univ, Fac Med, Dept Pediat Nephrol, Samsun, Turkey.

[Yilmaz, Dilek] Adnan Menderes Univ, Dept Pediat Nephrol, Fac Med, Aydin, Turkey.

[Tabel, Yilmaz] Inonu Univ, Dept Pediat Nephrol, Fac Med, Malatya, Turkey.

[Yildirim, Zeynep Y.] Istanbul Univ, Istanbul Fac Med, Dept Pediat Nephrol, Istanbul, Turkey.

[Bahat, Elif] Karadeniz Teknik Univ, Dept Pediat Nephrol, Fac Med, Trabzon, Turkey.

[Aksu, Bagdagul] Univ Hlth Sci, Haseki Educ & Res Hosp, Dept Pediat Nephrol, Istanbul, Turkey.

[celakil, Mehtap Ezel] Kocaeli Univ, Dept Pediat Nephrol, Fac Med, Kocaeli, Turkey.

[Tasdemir, Mehmet] Koc Univ, Dept Pediat Nephrol, Fac Med, Istanbul, Turkey.

[Benzer, Meryem] Bakirkoy Dr Sadi Konuk Training & Res Hosp, Dept Pediat Nephrol, Istanbul, Turkey.

[ozcelik, Gul] Univ Hlth Sci, Sisli Hamidiye Etfal Training & Res Hosp, Dept Pediat Nephrol, Istanbul, Turkey.

[Bakkaloglu, Sevcan A.] Gazi Univ, Dept Pediat Nephrol, Fac Med, Ankara, Turkey.