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The role of complement in kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

2024; Elsevier BV; Volume: 106; Issue: 3 Linguagem: Inglês

10.1016/j.kint.2024.05.015

1523-1755

Marina Vivarelli, Jonathan Barratt, Laurence H. Beck, Fádi Fakhouri, Daniel P. Gale, Elena Goicoechea de Jorge, Marta Mosca, Marina Noris, Matthew C. Pickering, Katalin Suszták, Joshua M. Thurman, Michael Cheung, Jennifer King, Michel Jadoul, Wolfgang C. Winkelmayer­, Richard J. Smith, Federico Alberici, Luca Antonucci, Tadej Avčin, Arvind Bagga, Ingeborg M. Bajema, Miquel Blasco, Sophie Chauvet, H. Terence Cook, Paolo Cravedi, Marie‐Agnès Dragon‐Durey, Lauren Fischer, Agnes B. Fogo, Ashley Frazer‐Abel, Véronique Frémeaux‐Bacchi, Nina Görlich, Mark Haas, Alister Humphreys, Vivekanand Jha, Arenn Jauhal, David Kavanagh, Andreas Kronbichler, Richard A. Lafayette, Lynne D. Lanning, Mathieu Lemaire, Moglie Le Quintrec, Christoph Licht, Adrian Liew, Stephen P. McAdoo, Nicholas R. Medjeral-Thomas, Pier Luigi Meroni, Johann Morelle, Carla Nester, Manuel Praga, Raja Ramachandran, Heather N. Reich, Giuseppe Remuzzi, Santiago Rodrı́guez de Córdoba, Gary Robinson, Pierre Ronco, Peter Rossing, David J. Salant, Sanjeev Sethi, Marianne Silkjaer, Wen‐Chao Song, Fabrizio Spoleti, Ronald P. Taylor, Nicole C. A. J. van de Kar, Cees van Kooten, Len Woodward, Yuzhou Zhang, Peter F. Zipfel, Marco Zuccato,

Blood groups and transfusion

Uncontrolled complement activation can cause or contribute to glomerular injury in multiple kidney diseases. While complement activation plays a causal role in atypical hemolytic uremic syndrome (aHUS) and C3 glomerulopathy (C3G), over the past decade a rapidly accumulating body of evidence has shown a role for complement activation in multiple other kidney diseases, including diabetic nephropathy and several glomerulonephritides. The number of available complement inhibitor therapies has also increased during the same period. In 2022 KDIGO convened a Controversies Conference, The Role of Complement in Kidney Disease, to address the expanding role of complement dysregulation in the pathophysiology, diagnosis, and management of various glomerular diseases, diabetic nephropathy, and other forms of HUS. Conference participants reviewed the evidence for complement playing a primary causal or secondary role in progression for several disease states and considered how evidence of complement involvement might inform management. Participating patients with various complement-mediated diseases and caregivers described concerns related to life planning, implications surrounding genetic testing, and the need for inclusive implementation of effective novel therapies into clinical practice. The value of biomarkers in monitoring disease course and the role of the glomerular microenvironment in complement response were examined, and key gaps in knowledge and research priorities were identified.