Delphi consensus on surrogate end points in C3 glomerulopathy and primary immune complex-mediated membranoproliferative glomerulonephritis
Introduction - C3 glomerulopathy (C3G) and primary immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) are rare kidney diseases driven by complement dysregulation. Proteinuria is a commonly used clinical end point in trials involving these conditions. However, its recognition...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
5 November 2025
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| In: |
Kidney international. Reports
Year: 2026, Volume: 11, Issue: 2, Pages: 1-8 |
| ISSN: | 2468-0249 |
| DOI: | 10.1016/j.ekir.2025.10.028 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.ekir.2025.10.028 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2468024925006722 
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| Author Notes: | Fernando Caravaca-Fontán, Fadi Fakhouri, Christoph Licht, Matthew C. Pickering, Franz Schaefer and Edwin Wong |
| Summary: | Introduction - C3 glomerulopathy (C3G) and primary immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) are rare kidney diseases driven by complement dysregulation. Proteinuria is a commonly used clinical end point in trials involving these conditions. However, its recognition as a validated end point by regulatory bodies remains limited, despite growing evidence supporting its prognostic value as a surrogate biomarker for the development of kidney failure. The aim of this study was to establish consensus on the clinical relevance of proteinuria as a prognostic and treatment end point in C3G and primary IC-MPGN. - Methods - A 2-round modified Delphi process was conducted, informed by literature review and expert input. A steering committee composed of 4 European nephrologists, 1 Canadian nephrologist, and 1 European rheumatologist developed 31 statements covering the following 3 domains: (i) treatment efficacy end points, (ii) current assessment end points, and (iii) the role of proteinuria. Statements formed part of an online survey using a 4-point Likert scale, distributed to a broader panel of nephrologists and kidney pathologists across Europe. - Results - Fifty-one and 50 responses were received in rounds 1 and 2. Of the 31 statements, 29 reached consensus (≥ 75% agreement). Key consensus points included the following: (i) reduction in proteinuria preserves long-term kidney function and is a treatment goal; (ii) longitudinal monitoring of proteinuria, alongside other markers is valuable for guiding treatment; (iii) a ≥ 50% proteinuria reduction over 6 months indicates meaningful therapeutic benefit; and (iv) proteinuria < 1 g/d is associated with improved outcomes. - Conclusion - This study demonstrates consensus supporting proteinuria as a meaningful treatment end point for C3G and primary IC-MPGN. |
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| Item Description: | Gesehen am 25.03.2026 |
| Physical Description: | Online Resource |
| ISSN: | 2468-0249 |
| DOI: | 10.1016/j.ekir.2025.10.028 |