Predictors of poor kidney outcome in children with C3 glomerulopathy
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ORIGINAL ARTICLE
Predictors of poor kidney outcome in children with C3 glomerulopathy Ayşe Seda Pınarbaşı 1 & Ismail Dursun 1 & Ibrahim Gokce 2 & Elif Çomak 3 & Seha Saygılı 4 & Meral Torun Bayram 5 & Osman Donmez 6 & Engin Melek 7 & Demet Tekcan 8 & Neslihan Çiçek 2 & Dilek Yılmaz 9 & Yılmaz Tabel 10 & Zeynep Y. Yıldırım 11 & Elif Bahat 12 & Mustafa Koyun 3 & Alper Soylu 5 & Nur Canpolat 4 & Bağdagül Aksu 13 & Mehtap Ezel Çelakıl 14 & Mehmet Taşdemir 15 & Meryem Benzer 16 & Gül Özçelik 17 & Sevcan A. Bakkaloğlu 18 & Ruhan Düşünsel 1 Received: 7 May 2020 / Revised: 13 August 2020 / Accepted: 24 September 2020 # IPNA 2020
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.
Keywords Complement . CKD stage 5 . Children . C3 glomerulopathy . Predictors
Introduction Ayşe Seda Pınarbaşı and Ismail Dursun contributed equally to this work. Supplementary Information The online version of this article (https:// doi.org/10.1007/s00467-020-04799-7) contains supplementary material, which is available to authorized users. * Ismail Dursun [email protected] Extended author information available on the last page of the article
C3 glomerulopathy (C3G) is a rare disease characterized by the accumulation of complement factors in glomeruli, due to abnormalities in the altern
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