Abstract:
Background. C3 glomerulopathy is a rare glomerular disease characterized by
dysregulation of the alternative complement pathway. Its clinical course is often
unpredictable, with an increased risk of progression to chronic kidney disease. Identifying
prognostic factors is essential for disease management.
Objective(s). To systematically review the literature to identify clinical and laboratory
predictors of long-term prognosis in C3 glomerulopathy in both pediatric and adult
populations.
Materials and methods. A systematic search was conducted in PubMed, Scopus, and Web of Science, including articles published between 2005 and 2024. A total of 42 studies were
selected that reported the clinical course of patients with C3 glomerulopathy in relation to
clinical, histological, and laboratory parameters associated with the disease.
Results. A comparative review of selected studies reveals that proteinuria over 3.5 g/day,
reduced eGFR (<60 ml/min/1.73 m²) at diagnosis, and persistently low serum C3 levels are
strongly associated with adverse renal outcomes. Chronic histological changes, such as
interstitial fibrosis and tubular atrophy, significantly correlate with the risk of progression
to end-stage renal disease. Favorable response to immunosuppressive treatment was
mainly seen in cases with early clinical remission and normalized complement levels. Recent
research also supports the relevance of complement activation biomarkers for risk
stratification and monitoring.
Conclusion(s). Clinical and paraclinical predictors such as severe proteinuria, reduced
glomerular filtration, and persistent hypocomplementemia are relevant predictors of renal
prognosis. Their regular evaluation may guide therapeutic decisions and long-term
monitoring in C3 glomerulopathy.
