PARTIAL RENAL RECOVERY IN AN ADULT PATIENT WITH C3 GLOMERULONEPHRITIS TREATED WITH MYCOPHENOLATE MOFETIL AND PREDNISOLONE
Dr Sivasaaini Sivakumaran1, Dr Amandie Abeynayake1, Miss Emerald Maddy3, Dr Thin Han2, Dr Zaw Thet1,2,4,5
1Department Of Medicine, Central Queensland Hospital and Health Service, Rockhampton , Australia, 2Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton , Australia, 3Rockhampton Grammar School, , Australia , 4Rockhampton Rural Clinical School, University of Queensland, , Rockhampton , Australia, 5School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
Background: C3 glomerulonephritis (C3GN) is a rare form of glomerulopathy affecting one to two individuals per million, and it results from dysregulation of the alternative complement pathway. C3GN poses a diagnostic and therapeutic challenge for clinicians, and considerable knowledge gaps exist in optimal disease management.
Case: A 48-year-old male presented with gross haematuria, increasing proteinuria (urine protein-creatinine ratio of 791mg/mmol), hypocomplementemia (normal C4 level and low C3 level at 0.43g/L), anaemia (Hb of 89g/L), and a decline of renal function (creatinine of 167umol/L and eGFR of 36mL/min/1.73m2). A provisional diagnosis of C3GN was made based on a renal biopsy which demonstrated diffuse endocapillary proliferative glomerulonephritis with dominant C3 deposition on immunofluorescence and subendothelial electron-dense deposits with focal basement membrane duplication on electron microscopy. On further evaluation, there was no evidence of post-infectious GN and monoclonal gammopathy – related GN . He was subsequently commenced on prednisolone 20mg daily for 4 months with tapering off in the next 2 months, and mycophenolate mofetil (MMF) 500mg BD with gradual up-titration of MMF to 1g BD. Following one year of treatment from diagnosis, the patient had a creatinine of 102umol/L and an eGFR of 74mL/min/1.73m2. The patient had improving microscopic haematuria (urine RBC of 70 x106/L) without any proteinuria, haemoglobin of 120g/L, and persistent hypocomplementemia with improving C3 level of 0.69g/L.
Conclusion: Persistence of microscopic haematuria and hypocomplementemia one year after treatment favours the diagnosis of C3 glomerulopathy. This case demonstrates the partial renal recovery of a patient with C3GN treated with prednisolone and MMF. Further research is needed to better understand its pathogenesis, identify effective treatment strategies and predictors of treatment response, and ultimately, optimise patient outcomes.
Biography:
Dr Sivasaaini Sivakumaran, M.D., is a physician trainee under the Royal Australian College of Physicians. Saaini commenced residency at Royal Brisbane and Women’s Hospital before embarking on her journey to work at the Port Moresby General Hospital in Papua New Guinea amidst diverse healthcare challenges. Through her dedication to medicine, advocacy, and education, Saaini continues to volunteer for the Queensland Medical Women’s Society and the DITS committee for the Australian Medical Association (AMAq). She is also concurrently an Associate Lecturer at the University of Queensland and is actively involved with teaching.