Kidney Week

Abstract: SA-PO838

Rebound Albuminuria after Discontinuation of Eculizumab in Three Cases of Idiopathic Membranoproliferative Glomerulonephritis

Session Information

• C3G, TMA, MGRS, Amyloidosis, and More
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Schuller, Max, Medical University of Graz, Division of Nephrology, Graz, Steiermark, Austria

Max Schuller, MD

• Aigner, Christof, Medical University Vienna, Division of Nephrology and Dialysis, Vienna, Vienna, Austria

Christof Aigner, MD

• Pollheimer, Marion Julia, Medical University of Graz, Institute of Pathology, Graz, Styria, Austria

Marion Julia Pollheimer, MD

• Rosenkranz, Alexander R., Medical University of Graz, Division of Nephrology, Graz, Steiermark, Austria

Alexander R. Rosenkranz, MD

• Eller, Kathrin, Medical University of Graz, Division of Nephrology, Graz, Steiermark, Austria

Kathrin Eller, MD

Introduction

Idiopathic membranoproliferative glomerulonephritis (MPGN) is a rare, clinically challenging entity that frequently affects young individuals and is associated with a poor prognosis. Evidence for an involvement of the complement system in the pathogenesis of MPGN has resulted in the testing of C5 convertase inhibition by eculizumab, but response to treatment has been heterogenous.

Case Description

Here, we describe three patients (two female patients and one male patient) from two different centers with idiopathic MPGN (one IC-MPGN and two C3-GN), who showed a substantial increase in albuminuria and serum-creatinine that was paralleled by a substantial increase in sC5b-9 after stopping eculizumab due to pregnancy in one case and non-response in the other two. Reintroduction of eculizumab resulted in a prompt decrease in sC5b-9 and albuminuria.

Discussion

Our observations highlight the potential risk of increased albuminuria following treatment cessation of eculizumab in MPGN, irrespective of apparent treatment response. It is tempting to speculate that C5 convertase inhibition may suppress disease activity even in apparent non-responders. One may hypothesize that treatment of MPGN might need another form of complement blockade that more effectively inhibits complement activation or inhibits the complement system at an earlier activation step in the complement cascade. Additionally, our report supports eculizumab continuation for MPGN during pregnancy.