Recent Advances in Targeting Complement in Glomerular Disease

Abstract

Several diseases are related to complement involvement. In particular, its role is essential for the pathogenesis of several renal disease. On the other hand, the complement role may also be protective, and this possibility should be well known when managing complement inhibitors. Complement inhibitors are relatively newly discovered therapies that are essential in some diseases, and in others improve the efficacy of the already known therapeutic measures that represent the standard of care. In the case of glomerular diseases, complement plays a role in almost all diseases. In some diseases, complement abnormalities represent the prevailing factor in the pathogenesis. In such diseases, complement inhibition represents an essential therapy. In other diseases, complement plays an important role, but other factors are involved in the pathogenesis. Clearly, in these diseases, complement inhibition represents a therapy that could be added to the standard of care therapy, according to the physician’s judgement. Examples of these diseases are lupus nephritis, thrombotic microangiopathy when associated to some cases of lupus nephritis, and IgA nephropathy. The latter is one of the first primary glomerulonephritides in which a relevant role of complement is documented. These three diseases are the object of this brief review. Particular concern should be given to ongoing clinical trials. Indeed, many of these anti-complement therapies are still in different phases of clinical trials. Finally, particular concern must be ascribed to the problem of associating these emerging therapies to already existing and proven treatments.