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- Title
Elevated urinary excretion of the C5b-9 complex in membranous nephropathy.
- Authors
Schulze, Matthias; Donadio Jr., James V.; Pruchno, Charles J.; Baker, Patricia J.; Johnson, Richard J.; Stahl, Role A. K.; Watkins, Sandra; Martin, Donald C.; Wurzner, Reinhard; Gotze, Otto; Couser, William G.
- Abstract
ln experimental membranous nephropathy, antibody binding to glomerular epithelial cell membrane antigens results in complement activation and formation of complement C5b-9 membrane attack complexes in glomeruli. During active disease, the C5b-9 complexes are shed into hie urine. To test the hypothesis that a similar mechanism might be operative in human membranous nephropathy, we measured urinary excretion of C5b-9 and C5 in 146 proteinuric patients with biopsy-proven glomerular diseases or diabetes mellitus. Urinary excretion of C5b-9 relative to C5 excretion was higher in 40 patients with membranous nephropathy than in 106 patients with proteinuria due to non-membranous glomerulonephritis when analyzed by covariance analysis (P < 0.025). Urinary C5b-9 excretion was higher in membranous nephropathy than in membranoproliferative glomerulonephritis (N = 13, P < 0.05), minimal change-focal sclerosis (N = 33, P < 0.001), mesangial proliferative glomerulonephritis (N = 9, P < 0.02) and IgA nephropathy (N = 7, P < 0.025). Urinary C5b-9 excretion was also higher in patients with lupus nephritis (N = 18, P < 0.02) compared to those with non-membranous glomerulonephritis. The lupus patients with the highest excretion had clinical or pathological features of membranous nephropathy. Nine patients with membranous nephropathy and elevated urinary C5b-9 excretion had a shorter duration of disease (P < 0.05), lower serum creatinine levels (P < 0.05) and more proteinuria (P < 0.02) than the 31 membranous nephropathy patients with normal values. The finding of increased urinary C5b-9 excretion in a subset of patients with idiopathic or lupus membranous nephropathy suggests an autoimmune basis for glomerular disease in these patients, and may indicate that these patients have ongoing immune deposit formation.
- Subjects
KIDNEY diseases; EPITHELIAL cells; CELL membranes; KIDNEY glomerulus; PROTEINURIA
- Publication
Kidney International, 1991, Vol 40, Issue 3, p533
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1038/ki.1991.242