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C1q nephropathy in a patient complicated with nephrotic syndrome and refractory to steroid therapy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:183-185. [DOI: 10.1016/j.jmii.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/22/2022]
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2
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Ma R, Wu D, He Z, Chang Q, Yang Y. Case Report: Complete Remission of C1q Nephropathy Treated With a Single Low-Dose Rituximab, a Reality or Coincidence? Front Pediatr 2020; 8:568773. [PMID: 33634050 PMCID: PMC7902059 DOI: 10.3389/fped.2020.568773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
C1q nephropathy is a glomerulopathy that is characterized by large amount of C1q deposits in the glomerular mesangium. It is a diagnosis of exclusion after ruling out systemic lupus erythematosus and membranoproliferative glomerulonephritis by systemic and serological examination. The pathogenesis of C1q nephropathy is unclear. In addition, there is very little generalizability in the treatment and prognosis for pediatric C1q nephropathy due to diversities in clinical manifestations and pathological types. Rituximab is a human/mouse chimeric monoclonal antibody against CD20, which is primarily used for treating lymphomas and, most recently, has been used to treat certain kidney diseases including C1q nephropathy. In this report, we used one quarter of the typical dose of rituximab for lymphoma treatment to achieve complete remission in a C1q nephropathy patient, significantly reducing deposition of immune complexes and glomerular damage. This case indicates that dosage reconsiderations may be necessary for rituximab in treatment of pediatric C1q nephropathy.
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Affiliation(s)
- Rui Ma
- Department of Pediatric Nephrology, Lanzhou University Second Hospital, Lanzhou, China.,Department of Nephrology, Gansu Children's Hospital, Lanzhou, China
| | - Dengyan Wu
- Department of Pediatric Nephrology, Lanzhou University Second Hospital, Lanzhou, China.,Department of Nephrology, Gansu Children's Hospital, Lanzhou, China
| | - Zhiqin He
- Department of Pediatric Nephrology, Lanzhou University Second Hospital, Lanzhou, China.,Department of Nephrology, Gansu Children's Hospital, Lanzhou, China
| | - Qian Chang
- Department of Pediatric Nephrology, Lanzhou University Second Hospital, Lanzhou, China.,Department of Nephrology, Gansu Children's Hospital, Lanzhou, China
| | - Yonghong Yang
- Department of Pediatric Nephrology, Lanzhou University Second Hospital, Lanzhou, China.,Department of Nephrology, Gansu Children's Hospital, Lanzhou, China.,Department of Pediatrics, Children's Hospital of Xi'an International Medical Center, Xi'an, China
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C1q nephropathy in adults is a form of focal segmental glomerulosclerosis in terms of clinical characteristics. PLoS One 2019; 14:e0215217. [PMID: 31002691 PMCID: PMC6474651 DOI: 10.1371/journal.pone.0215217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/28/2019] [Indexed: 11/24/2022] Open
Abstract
Although C1q nephropathy (C1qN) was introduced three decades ago, the clinical significance and renal outcomes of C1qN remain unclear. This study aimed to evaluate the clinical characteristics of C1qN, including renal outcomes, by performing a matched comparison within a multicenter cohort. We enrolled 6,413 adult patients who underwent kidney biopsy between January 2000 and January 2018 at three tertiary hospitals in Korea. We compared the clinical characteristics of 23 patients with C1qN with those of patients with focal segmental glomerulosclerosis (FSGS) or minimal change disease (MCD) who were matched by age, sex, diabetic status, and a period of biopsy. Histological and clinical parameters in patients with C1qN were also evaluated according to the different pathological phenotypes. For a mean follow-up period of 92 months, 4 patients with C1qN (17.4%) developed end-stage renal disease (ESRD). None of the matched patients with MCD had ESRD, but 7 (30.4%) of patients with FSGS progressed to ESRD, which was not different from that of C1qN patients (p = 0.491). Laboratory and pathological findings, except segmental glomerulosclerosis, were not notably different between FSGS and C1qN. The presence of segmental glomerulosclerosis, mesangial hypercellularity, and podocyte effacement did not affect both the short- and long-term renal outcomes in patients with C1qN. Our study showed that the renal outcomes of C1qN are comparable with those of FSGS, and not with MCD. Specific pathological findings, including segmental glomerulosclerosis in C1qN, were not associated with renal outcomes, which may suggest homogeneity in the clinical features of C1qN.
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Varshavsky VA, Grishina AN, Chebotareva NV, Gudkova EI. [The clinical and morphological characteristics of C1q glomerulopathy]. Arkh Patol 2018; 80:46-51. [PMID: 29460894 DOI: 10.17116/patol201880146-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
C1q glomerulopathy is a rare variety of chronic glomerulonephritis manifested as C1q deposition revealed by immunofluorescence microscopy. The pathogenesis and etiology of the disease have not been studied. The paper deals with the results of clinical, morphological, immunofluorescence, and electron microscopic examinations in 13 patients with C1q glomerulopathy. Light microscopy more commonly revealed membranous nephropathy, mesangioproliferative glomerulonephritis, and nephrosclerosis. Immunofluorescence microscopy detected a C1q fraction in association with other deposits, more frequently IgM and IgG ones. A correlation was found between the clinical presentation and morphological form of chronic glomerulonephritis.
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Affiliation(s)
- V A Varshavsky
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A N Grishina
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - N V Chebotareva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - E I Gudkova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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Ramachandran R, Bharati J, Jha V. Successful treatment of C1q nephropathy with CD19 targeted Rituximab therapy. Nephrology (Carlton) 2017; 22:265. [PMID: 28205352 DOI: 10.1111/nep.12757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, New Delhi, India
| | - Joyita Bharati
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
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Yang J, Zhang BL. [Advances in clinical research on C1q nephropathy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016. [PMID: 27817791 DOI: 10.7499/j.issn.1008-8830.2016.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
C1q nephropathy is a rare type of glomerulonephritis manifested as the deposition of C1q in the glomerular mesangium during immunofluorescent staining. Systemic lupus erythematosus and type I membranoproliferative glomerulonephropathy need to be excluded in the diagnosis of C1q nephropathy. C1q nephropathy has various manifestations under a light microscope, mainly including minimal change disease, focal segmental glomerulosclerosis, and proliferative glomerulonephritis. This disease is mainly manifested as persistent proteinuria or nephrotic syndrome and occurs more frequently in boys. Currently, glucocorticoids are mainly used for the treatment of this disease. Patients with C1q nephropathy show a good response to immunosuppressant treatment, but have a high rate of glucocorticoid resistance. Therefore, in this case, methylprednisolone pulse therapy or a combination with immunosuppressant treatment helps to achieve a good prognosis.
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Affiliation(s)
- Juan Yang
- Department of Nephrology, Tianjin Children's Hospital, Tianjin 300074, China.
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Devasahayam J, Erode-Singaravelu G, Bhat Z, Oliver T, Chandran A, Zeng X, Dakshinesh P, Pillai U. C1q Nephropathy: The Unique Underrecognized Pathological Entity. Anal Cell Pathol (Amst) 2015; 2015:490413. [PMID: 26640759 PMCID: PMC4657067 DOI: 10.1155/2015/490413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/08/2015] [Indexed: 11/17/2022] Open
Abstract
C1q nephropathy is a rare glomerular disease with characteristic mesangial C1q deposition noted on immunofluorescence microscopy. It is histologically defined and poorly understood. Light microscopic features are heterogeneous and comprise minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and proliferative glomerulonephritis. Clinical presentation is also diverse, and ranges from asymptomatic hematuria or proteinuria to frank nephritic or nephrotic syndrome in both children and adults. Hypertension and renal insufficiency at the time of diagnosis are common findings. Optimal treatment is not clear and is usually guided by the underlying light microscopic lesion. Corticosteroids are the mainstay of treatment, with immunosuppressive agents reserved for steroid resistant cases. The presence of nephrotic syndrome and FSGS appear to predict adverse outcomes as opposed to favorable outcomes in those with MCD. Further research is needed to establish C1q nephropathy as a universally recognized distinct clinical entity. In this paper, we discuss the current understanding of pathogenesis, histopathology, clinical features, therapeutic options, and outcomes of C1q nephropathy.
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Affiliation(s)
| | | | - Zeenat Bhat
- Wayne State University, 42 W. Warren Avenue, Detroit, MI 48202, USA
| | - Tony Oliver
- Sanford University, 1305 W. 18th Street, Sioux Falls, SD 57105, USA
| | - Arul Chandran
- University of MO, 1 Hospital Drive, Columbia, MO 65201, USA
| | - Xu Zeng
- Temple University, 1801 N. Broad Street, Philadelphia, PA 19122, USA
| | - Paramesh Dakshinesh
- Presence Covenant Medical Center, 1400 W. Park Street, Urbana, IL 61801, USA
| | - Unni Pillai
- Ball Memorial Hospital, 2401 W. University Avenue, Muncie, IN 47303, USA
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Tibor Fülöp T, Csongrádi É, Lerant AA, Lewin M, Lewin JR. Resolution of C1q deposition but not of the clinical nephrotic syndrome after immunomodulating therapy in focal sclerosis. J Nephropathol 2015; 4:54-8. [PMID: 25964890 PMCID: PMC4417671 DOI: 10.12860/jnp.2015.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/25/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The natural evolution of C1q nephropathy (C1qNP) during immunosuppressive treatment is relatively little studied or understood. CASE PRESENTATION A 30 year-old Caucasian female was referred to us for further management of biopsy-proven C1qNP and severe nephrotic syndrome. Serologic work-up remained negative, including complement C3 and C4 levels and repeated testing for antinuclear antibodies. A renal biopsy revealed minimal change nephropathy vs. focal sclerosis on light microscopy and C1qNP on immunopathology. She has failed trials of high-dose oral prednisone, mycophenolate mofetil 1,500 mg twice a day and a subsequent regimen of monthly IV cyclophosphamide 750 mg × 9 cycles. She also received the maximum tolerated angiotensin-converting enzyme inhibitor and spironolactone therapy. Random urine protein-to-creatinine (UPC) ratio predicted proteinuria in the range between 5-35 gm/day, while serum creatinine rose progressively from 1.0 mg/dL to 1.4 mg/dL (to convert to μmol/L, multiply by 88.4). A decision was made to repeat renal biopsy to reassess the underlying histology. The biopsy revealed focal sclerosis but no C1q deposition. CONCLUSIONS Our case illustrates at least two points: first, an established pathologic diagnosis does not obviate the need for repeated renal biopsy later on, should diagnostic uncertainty persist. Second, histological diagnoses may evolve over time, especially in a patient receiving active and powerful immune-modulating treatment. In our case, the clinical nephrosis did not change with immunosuppressive therapy while C1q deposition ceased, making this latter entity likely the immunologically mediated process.
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Affiliation(s)
- Tibor Tibor Fülöp
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Éva Csongrádi
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA ; Department of Medicine, Medical and Health Science Centre University of Debrecen, Hungary
| | - Anna A Lerant
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Jack R Lewin
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA Case Report
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Malleshappa P, Vankalakunti M. Diverse clinical and histology presentation in c1q nephropathy. Nephrourol Mon 2013; 5:787-91. [PMID: 24282787 PMCID: PMC3830903 DOI: 10.5812/numonthly.8308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/29/2012] [Accepted: 11/11/2012] [Indexed: 11/16/2022] Open
Abstract
Patients presenting with nephrotic syndrome with or without nephritic illness rarely come across with the diagnosis of 'C1q nephropathy'. This entity is purely diagnosed with the help of immunofluorescence like IgA nephropathy. Clinical presentation is heterogenous, ranging from nephrotic range proteinuria to sub-nephrotic state; and with or without hematuria / renal insufficiency. Similarly, the concept of 'C1q nephroapthy' has periodically evolved since its original description by Jenette and Hipp in 1985. Here the pathophysiology, histologic findings / diagnostic and therapeutic options in patients with C1q nephropathy are discussed.
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Affiliation(s)
- Pavan Malleshappa
- Division of Nephrology, Department of Medicine, Adichunchanagiri Institute of Medical Sciences, Mandya, India
- Corresponding author: Pavan Malleshappa, Division of Nephrology, Department of Medicine, Adichunchanagiri Institute of Medical Sciences, B G Nagar, Nagamangala Taluk, Mandya-571448, Karnataka State, India. Tel: +91-8172251707, Fax: +91-8234287242, E-mail:
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Ejaz AA, Asmar A, Alsabbagh MM, Ahsan N. Rituximab in immunologic glomerular diseases. MAbs 2012; 4:198-207. [PMID: 22377738 PMCID: PMC3361655 DOI: 10.4161/mabs.4.2.19286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/26/2011] [Accepted: 01/07/2012] [Indexed: 02/06/2023] Open
Abstract
Experimental data suggest that the B-cell antigen CD20 may play a significant role in the pathogenesis of many diseases including glomerular diseases. These and other findings underpin the central concept of B-cell-depleting therapies that target CD20 antigen as treatments for lupus nephritis, idiopathic membranous nephropathy, focal segmental glomerulosclerosis, cryglobulinemic glomerulonephritis, antibody mediated renal allograft rejection and recurrent glomerulonephritis in renal allograft. Use of rituximab as a B-cell depleting therapy has been associated with clinical improvement and has emerged as a possible adjunct or alternative treatment option in this field of nephrology.
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Affiliation(s)
- A Ahsan Ejaz
- Department of Nephrology; Hypertension and Transplantation; University of Florida; Gainesville, FL USA
| | - Abdo Asmar
- Department of Clinical Sciences; University of Central Florida; Orlando, FL USA
| | - Mourad M Alsabbagh
- Department of Nephrology; Hypertension and Transplantation; University of Florida; Gainesville, FL USA
| | - Nasimul Ahsan
- Fayetteville Veterans Administration Medical Center; Fayetteville, NC USA
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