ISN-IPNA Webinar: The many faces of complement-related kidney disease – a low resource perspective
- 2 PM CEST
A 12-year-old girl was referred with a 1-week history of fever, oligo-anuria, generalized edema, and shock with purpura, hematemesis and melena. Recurrent episodes of malaria in the past. Laboratory evaluation: severe azotemia, hyperkalemia, anemia (Hb 6.2 g/dL) and thrombocytopenia (43 x10⁹/L). Malaria test was negative, INR 1.6, ALT 150 U/L, AST 535 U/L, Coombs test negative, C4 and C3 decreased. Initial treatment included hemodialysis, RBCs, platelets, frozen plasma, and antibiotics, and later methylprednisolone. Kidney function recovered partially, and urine output reached 1.3 mL/kg/h. Unfortunately, she developed intractable seizures on day 47 and died of cardiopulmonary arrest.
Learning objectives:
- Review the etiology of platelet and complement consumption in thrombocytopenia syndromes
- Recognize subtle laboratory signs indicating thrombotic microangiopathy (TMA) or a TMA-like condition
- Appreciate the protean (multifaceted) manifestations of childhood SLE (cSLE) and lupus nephritis
- Understand the use of complement tests
- Be aware of existing deficits in the diagnosis, referral and treatment of cSLE and TMA in many low- or low-middle income countries
Further reading:
- Totapally BR, Totapally A, Martinez PA. Thrombocytopenia in Critically Ill Children: A Review for Practicing Clinicians. Children (Basel) 2025. doi: 10.3390/children12010083
- Yoshida Y, Nishi H. The role of the complement system in kidney glomerular capillary thrombosis. Front Immunol 2022. doi: 10.3389/fimmu.2022.981375
- Azoulay E, Zuber J, Bousfiha AA, Long Y et al. Complement system activation: bridging physiology, pathophysiology, and therapy. Intensive Care Med 2024. doi: 10.1007/s00134-024-07611-4.
- Venturelli V, Maranini B, Tohidi-Esfahani I et al. Can complement activation be the missing link in antiphospholipid syndrome? Rheumatology (Oxford) 2024. doi: 10.1093/rheumatology/keae178
- Nordmann-Gomes A, Cojuc-Konigsberg G, Hernández-Andrade A et al. Lupus nephritis randomised controlled trials: evidence gaps and under-represented groups. Lupus Sci Med 2024. doi: 10.1136/lupus-2024-001331
- Aggarwal A, Fernandes TAP, Migowa A et al. Childhood-Onset Systemic Lupus Erythematosus (cSLE): An International Perspective. Curr Allergy Asthma Rep 2024. doi: 10.1007/s11882-024-01169-3
- Niel O, Dookhun D, Caliment A. Performance evaluation of large language models in pediatric nephrology clinical decision support: a comprehensive assessment. Pediatr Nephrol 2025. doi: 10.1007/s00467-025-06819-w
Moderator
Alison Ma (Hong Kong)
Speakers
Martin Bitzan (UAE)
Gilbert Rugamba (Rwanda)
Marcel Tuyizere (Rwanda)