Complement-mediated renal diseases after kidney transplantation - current diagnostic and therapeutic options in de novo and recurrent diseases

Table 5 Recommended therapy approach for C3 glomerulopathy based on small prospective trial, case reports, and expert opinion

All patients	Moderate disease	Severe disease
Lipid control	Urine protein > 500 mg/24 h despite supportive therapy, or	Urine protein > 2000 mg/24 h despite immunosuppression and supportive therapy or
Optimal BP control (< 90% in children and ≤ 120/80 mm Hg in adults)	Moderate inflammation on renal biopsy or	Severe inflammation represented by marked endo- or extracapillary proliferation with/without crescent formation despite immunosuppression and supportive therapy or
Optimal nutrition for both normal growth in children and healthy weight in adults	Recent increase in serum creatinine suggesting risk for progressive disease	Increased S. Cr suggesting risk for progressive disease at onset despite immunosuppression and supportive therapy
	Recommendation	Recommendations
	Prednisone	Methylprednisolone pulse-dosing as well as other anti-cellular immune suppressants have had limited success in rapidly progressive disease
	Mycophenolate mofetil	Data are insufficient to recommend eculizumab as a first-line agent for the treatment of rapidly progressive disease

Adapted from Goodship et al[12].