Inherited Kidney Complement Diseases

Clin J Am Soc Nephrol. 2021 Jun;16(6):942-956. doi: 10.2215/CJN.11830720. Epub 2021 Feb 3.


In the past 20 years, we have witnessed tremendous advances in our ability to diagnose and treat genetic diseases of the kidney caused by complement dysregulation. Staggering progress was realized toward a better understanding of the genetic underpinnings and pathophysiology of many forms of atypical hemolytic uremic syndrome (aHUS) and C3-dominant glomerulopathies that are driven by complement system abnormalities. Many of these seminal discoveries paved the way for the design and characterization of several innovative therapies, some of which have already radically improved patients' outcomes. This review offers a broad overview of the exciting developments that have occurred in the recent past, with a particular focus on single-gene (or Mendelian), complement-driven aHUS and C3-dominant glomerulopathies that should be of interest to both nephrologists and kidney researchers. The discussion is restricted to genes with robust associations with both aHUS and C3-dominant glomerulopathies (complement factor H, complement component 3, complement factor H-related proteins) or only aHUS (complement factor B, complement factor I, and membrane cofactor protein). Key questions and challenges are highlighted, along with potential avenues for future directions.

Keywords: complement; genetic renal disease; glomerulopathy; hemolytic uremic syndrome; human genetics; immune complexes; membranoproliferative glomerulonephritis (MPGN).

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Atypical Hemolytic Uremic Syndrome / genetics*
  • Complement C3 / genetics*
  • Complement C3 / physiology
  • Complement Factor B / genetics*
  • Complement Factor B / physiology
  • Complement Factor H / genetics
  • Complement Factor H / physiology
  • Humans
  • Kidney Diseases / genetics*


  • C3 protein, human
  • CFH protein, human
  • Complement C3
  • Complement Factor H
  • Complement Factor B