Lian Rong, Li Wenchuan, Li Yuejiao, Lian Xinji, Yu Shengyou, Shi Wanxin, Yu Jianwen, Chen Wei, Li Jianbo, He Feng
Department of Nephrology, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Department of Clinical Medical Research, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Clin Kidney J. 2025 Jul 24;18(8):sfaf235. doi: 10.1093/ckj/sfaf235. eCollection 2025 Aug.
Thrombotic microangiopathy (TMA) is a major complication of malignant hypertension (mHTN). Abnormal complement activation has been recognized as a key determinant of TMA, but less is known about the prognostic significance of complement abnormality in patients with mHTN-associated TMA.
A prospective cohort study was performed in patients with mHTN. All participants had concomitant TMA proven by kidney biopsy after admission between 2008 and 2023, and were divided into normal and abnormal complement groups based on serum C3 and C4 levels. Cox regression models were used to identify risk factors for renal prognosis.
A total of 189 mHTN patients with TMA were enrolled in the current study, including 161 (85.2%) patients with normal complement levels and 28 (14.8%) patients with abnormal complement levels. Compared to the normal complement group, patients in the abnormal complement group had lower levels of BMI, hemoglobin, and platelet counts, and more intravascular erythrocyte fragments (21.4% vs 7.5%, = .02). Notably, a substantial glomerular deposition of C3c and C5b-9 was observed in the abnormal complement group, indicating complement activation . Importantly, abnormal complement levels were independently associated with worse renal function recovery [hazard ratio (HR), 0.368; 95% CI, 0.140-0.970; = .043]. In addition, the glomerular sclerosis ratio (HR, 0.971; 95% CI, 0.953-0.989; = .002) remained an independent predictor of poor renal outcomes.
Patients with abnormal complement levels have worse renal prognosis, suggesting that complement abnormality predisposes to the progression of mHTN-associated TMA disease.
血栓性微血管病（TMA）是恶性高血压（mHTN）的主要并发症。补体异常激活已被认为是TMA的关键决定因素，但关于mHTN相关TMA患者补体异常的预后意义知之甚少。
对mHTN患者进行了一项前瞻性队列研究。所有参与者在2008年至2023年入院后经肾活检证实伴有TMA，并根据血清C3和C4水平分为补体正常组和异常组。采用Cox回归模型确定肾脏预后的危险因素。
本研究共纳入189例mHTN合并TMA患者，其中补体水平正常者161例（85.2%），补体水平异常者28例（14.8%）。与补体正常组相比，补体异常组患者的体重指数、血红蛋白和血小板计数较低，血管内红细胞碎片更多（21.4%对7.5%，P = 0.02）。值得注意的是，在补体异常组中观察到大量C3c和C5b-9在肾小球沉积，表明补体激活。重要的是，补体水平异常与肾功能恢复较差独立相关[风险比（HR），0.368；95%置信区间，0.140 - 0.970；P = 0.043]。此外，肾小球硬化率（HR，0.971；95%置信区间，0.953 - 0.989；P = 0.002）仍然是肾脏预后不良的独立预测因素。
补体水平异常的患者肾脏预后较差，提示补体异常易导致mHTN相关TMA疾病进展。
