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case_images: C3c staining of kidney biopsies before and after initiation of pegcetacoplan treatment (A) C3c staining from the January 2023 kidney biopsy; (B) C3c staining from the November 2023 kidney biopsy (6 months after pegcetacoplan treatment was initiated in May 2023).
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case_images: AKI and a repeat biopsy 4 months after initiation of high-dose steroids and MMF showed highly active C3GN but no evidence of crescents (Figure 1A). A steroid taper was initiated due to the poor response to and potential adverse effects of prednisone. A kidney biopsy after 6 months of pegcetacoplan treatment showed mesangial and focal endocapillary proliferative glomerulonephritis with isolated C3 deposition by immunofluorescence consistent with the patient's previous diagnosis of C3GN (Figure 1B).
case_images: Laboratory values over time. MMF, mycophenolate mofetil; uPCR, urine protein-to-creatinine ratio. The y-axis labels on the left (uPCR) and right (serum C3, haemoglobin, albumin, and creatinine) are colour-coded to match the corresponding lines on the graph. The initiation and discontinuation of medications are indicated by the length of the horizontal lines at the top of the graph. C3 levels must be multiplied by 10 to obtain mg/dL values presented in text. Dates are day/month/year.
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case_images: A clinically significant improvement in serum C3 levels was observed within 1 week of pegcetacoplan initiation (142 mg/dL), along with a sustained reduction in uPCR (Figure 2).