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Diagnosis: C3 Glomerulonephritis
This case is very characteristic, with IF demonstrating exclusive C3 deposits, without immunoglobulins, marked C3 hypocomplementemia, which has been persistent, and a characteristic membranoprolifertive pattern (MPGN). We still do not have information on what type of alteration in the alternative complement pathway this patient presents, as studies are still pending to determine deficiencies or autoantibodies against the different factors involved in the regulation of said complement pathway.
The morphological and clinical expression of C3GN is very variable, from subtle clinical or paraclinical alterations to very clinically aggressive glomerulonephritis. Likewise in morphology, we can see cases from only mild mesangial hypercellularity to very proliferative glomerulonephritis, even crescentic, however, the most frequently described pattern is that of MPGN, as in the case we present.
See the chapter: Membranoproliferative GN of our Tutorial.
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References
- Honma S, Sato N, Sakaguchi R, Hashiguchi A, Uesugi N, Nakamura Y, Sasano H, Joh K. Morphological and etiological analyses of C3 and non-C3 glomerulonephritis in primary membranoproliferative glomerulonephritis using periodic acid-methenamine silver stain electron microscopy: a retrospective multicentered study. Med Mol Morphol. 2024;57(1):23-34. [PubMed link]
- Ponticelli C, Calatroni M, Moroni G. C3 glomerulopathies: dense deposit disease and C3 glomerulonephritis. Front Med (Lausanne). 2023;10:1289812. [PubMed link]
- Puri P, Walters GD, Fadia MN, Konia M, Gibson KA, Jiang SH. The impact of reclassification of C3 predominant glomerulopathies on diagnostic accuracy, outcome and prognosis in patients with C3 glomerulonephritis. BMC Nephrol. 2020;21(1):265. [PubMed link]