J. Zwirner et al., ACTIVATED COMPLEMENT C3 - A POTENTIALLY NOVEL PREDICTOR OF PROGRESSIVE IGA NEPHROPATHY, Kidney international, 51(4), 1997, pp. 1257-1264
In the search for a serologic marker of disease activity, we measured
concentrations of activated C3 (actC3, that is, neoantigens developing
after C3 activation on breakdown products), C4-C3 complexes and solub
le C5b-9 (sC5b-9) in one or two plasma samples from adult patients wit
h IgA nephropathy (IgAN, N = 50) or Henoch-Schonlein purpura (HSP, N =
4). As controls, 20 patients with non-immune renal disease, but compa
rable age, degree of proteinuria, renal dysfunction and prevalence of
hypertension were studied. Compared to controls, actC3 levels were ele
vated in 30% of the patients with IgAN and one of the HSP patients. C4
-C3 complexes were elevated in only 8% of the IgAN patients, and sC5b-
9 levels were within the control range in all IgAN and HSP patients. I
n IgAN patients with elevated actC3 levels, proteinuria and hematuria
were more pronounced than in those with normal levels. Elevated plasma
concentrations of actC3 at the first presentation correlated with sub
sequent deterioration of renal function both in patients with initiall
y normal and already impaired renal function (r = -0.56, N = 44, P = 0
.003). The five IgAN patients with elevated actC3 on both occasions of
obtaining plasma showed the most rapid loss of renal function. We con
clude that mainly alternative pathway complement activation can be dem
onstrated in patients with IgAN and HSP. In IgAN patients the presence
of complement activation is associated with more severe renal disease
. Further studies are warranted to examine the clinical usefulness of
actC3 as a predictor of the subsequent course of IgAN.