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Hi – my nephew is a 10 year old boy who has had two incidents of kidney failure due to an autoimmune response to infection (strep and mycopalsma) – his doctor says his blood work is still showing persistent low C3 and low C4. He is working with an ND but do you have any suggestions on how to raise these?
Many thanksI assume this is strep glomerulonephritis? Are his total Qn Ig’s normal or low?
Has he had a workup for Goodpasture’s syndrome?
Was anything done in tx that may explain the low C3 and C4?
What’s being done to address the strep?strep glomerulonephritis was the likely prognosis but the doctors have not identified the pathogen so could be strep or mycoplasma – ASOT was 400 at one point but reduced down to below 200. 2 x glomerulonephritis in 2019 and clear in 2020 until mild flare a week ago triggered by a URTI (was not hospitalized this time).
C3 Nephritic Factor Positive.
Anti Nuclear Antibodies Negative
No blood work for overall IgG/IgA yet
Faecal SIgA normal range.
Neutrophils persistently high (8.3-10.6), eosinophils persistently mildly raised.
Dr has him on prophylactic antibiotics.
No screening for Good Pastures yetThank you for any insight you have
The C3 Nephritic Factor reflects an autoimmune response, stabilizing C3, the net effect of which will be a lowering of the C3 level.
This patient needs to be treated as an autoimmune patient (Treg and Th1 promotion). Additionally, anti-pathogenic support (Th1 and NK cells) is also appropriate, to push back against the pathogen burden. It’s good that the patient can generate an ASO elevation, as it suggests there isn’t a blank spot with regard to immune response against strep.This paper might be useful. You’ll find several case reports like it.
Am J Nephrol. 1990;10(5):426-30. doi: 10.1159/000168162.
Persistent low C3 levels associated with meningococcal meningitis and membranoproliferative glomerulonephritis
J Fernandez-Sola 1, R Monforte, E Ponz, F Lozano, M Plana, J Montoliu, A Torras, M IngelmoI can’t give many suggestions as I am not his practitioner but bring these points up with his ND and see what can be done.
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