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C3 Glomerulonephritis Associated With Anti-complement Factor B Antibodies Following Anti-cancer Treatment With Pembrolizumab

Lookup NU author(s): Professor Kevin MarchbankORCiD, Professor David KavanaghORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).

Abstract

© 2026 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/. Complement 3 (C3) glomerulonephritis (C3GN) is a rare diagnosis based on predominant C3 glomerular deposition relative to other immune reactants on kidney biopsy. It is typically a membranoproliferative glomerulonephritis with or without crescents. Causes are heterogenous, ranging from genetic defects to acquired autoimmunity against complement factors. A 78-year-old male presented with stage 3 acute kidney injury and microscopic hematuria on the background of a diarrheal illness, urinary tract infection and 2 years treatment with pembrolizumab for metastatic bladder cancer. Kidney histology revealed a crescentic C3GN with intratubular red blood cell casts. Complement analysis showed an acquired autoimmunity with circulating factor B antibodies. Despite treatment with corticosteroids, plasma exchange, cyclophosphamide and eculizumab he remained dialysis-dependent. This is an unusually aggressive case of C3GN. PD-1 inhibitors, such as pembrolizumab, are known to predispose to loss of tolerance and generation of autoantibodies. In this case, factor B autoantibodies were detected in association with C3GN.

Publication metadata

Author(s): Stroppou P, Asaelof L, Panayides A, Arsali M, Spartalis M, Kevrekidou S, Christofi T, Theophanous T, Michaelides C, Marchbank KJ, Dimitriou K, Kavanagh D, Mitsides N

Publication type: Article

Publication status: Published

Journal: Kidney Medicine

Year: 2026

Volume: 8

Issue: 5

Print publication date: 01/05/2026

Online publication date: 26/02/2026

Acceptance date: 02/04/2018

Date deposited: 14/04/2026

ISSN (electronic): 2590-0595

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.xkme.2026.101311

DOI: 10.1016/j.xkme.2026.101311

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