The Rational Use of Complement Inhibitors in Kidney Diseases

Fadi Fakhouri; Nora Schwotzer; Déla Golshayan; Véronique Frémeaux-Bacchi

doi:10.1016/j.ekir.2022.02.021

The Rational Use of Complement Inhibitors in Kidney Diseases

Kidney Int Rep. 2022 Mar 4;7(6):1165-1178. doi: 10.1016/j.ekir.2022.02.021. eCollection 2022 Jun.

Authors

Fadi Fakhouri¹, Nora Schwotzer¹, Déla Golshayan², Véronique Frémeaux-Bacchi³

Affiliations

¹ Service de Néphrologie et d'hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Lausanne, Switzerland.
² Centre de Transplantation d'organes, Département de Médecine, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Lausanne, Switzerland.
³ Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d'Immunologie, Paris University, Paris, France.

Abstract

The development of complement inhibitors represented one of the major breakthroughs in clinical nephrology in the last decade. Complement inhibition has dramatically transformed the outcome of one of the most severe kidney diseases, the atypical hemolytic uremic syndrome (aHUS), a prototypic complement-mediated disorder. The availability of complement inhibitors has also opened new promising perspectives for the management of several other kidney diseases in which complement activation is involved to a variable extent. With the rapidly growing number of complement inhibitors tested in a rapidly increasing number of indications, a rational use of this innovative and expensive new therapeutic class has become crucial. The present review aims to summarize what we know, and what we still ignore, regarding complement activation and therapeutic inhibition in kidney diseases. It also provides some clues and elements of thoughts for a rational approach of complement modulation in kidney diseases.

Keywords: complement; complement inhibitors; glomerular diseases.

Publication types

Review