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Lookup NU author(s): Professor Kevin MarchbankORCiD, Professor David KavanaghORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2026 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/. Complement 3 (C3) glomerulonephritis (C3GN) is a rare diagnosis based on predominant C3 glomerular deposition relative to other immune reactants on kidney biopsy. It is typically a membranoproliferative glomerulonephritis with or without crescents. Causes are heterogenous, ranging from genetic defects to acquired autoimmunity against complement factors. A 78-year-old male presented with stage 3 acute kidney injury and microscopic hematuria on the background of a diarrheal illness, urinary tract infection and 2 years treatment with pembrolizumab for metastatic bladder cancer. Kidney histology revealed a crescentic C3GN with intratubular red blood cell casts. Complement analysis showed an acquired autoimmunity with circulating factor B antibodies. Despite treatment with corticosteroids, plasma exchange, cyclophosphamide and eculizumab he remained dialysis-dependent. This is an unusually aggressive case of C3GN. PD-1 inhibitors, such as pembrolizumab, are known to predispose to loss of tolerance and generation of autoantibodies. In this case, factor B autoantibodies were detected in association with C3GN.
Author(s): Stroppou P, Asaelof L, Panayides A, Arsali M, Spartalis M, Kevrekidou S, Christofi T, Theophanous T, Michaelides C, Marchbank KJ, Dimitriou K, Kavanagh D, Mitsides N
Publication type: Article
Publication status: Published
Journal: Kidney Medicine
Year: 2026
Volume: 8
Issue: 5
Print publication date: 01/05/2026
Online publication date: 26/02/2026
Acceptance date: 02/04/2018
Date deposited: 14/04/2026
ISSN (electronic): 2590-0595
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.xkme.2026.101311
DOI: 10.1016/j.xkme.2026.101311
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