Blocking C3 drops proteinuria by four-fifths in a disease with nothing else

The edition in brief

Four findings for the nephrology desk, plus one regulatory action. Twenty-five patients with C3 glomerulopathy or primary immune-complex membranoproliferative glomerulonephritis, median age 14.9 years and a median 2.7 years after diagnosis, started pegcetacoplan outside clinical trials and were followed through the CompCure registry. Median urine protein-to-creatinine ratio fell 81% by six months, from a baseline of 3.5 g/g, with 68% reaching under 1 g/g and 12% complete and 64% partial remission. Mean eGFR rose 9.4 mL/min/1.73 m2 by month three and 12 by month six. No serious adverse events occurred over 222 patient-months. A double-blind trial randomised 72 patients with CKD stage 3 or 4 to Lactobacillus plantarum or placebo for six months. eGFR rose in the probiotic group and fell on placebo, and no probiotic patient progressed against 8.6% on placebo; urinary indoxyl sulfate did not differ. The abstract reports significance without effect magnitudes. A meta-analysis of nine case-control studies covering 880 people with diabetes and 1,008 with diabetic nephropathy found the ELMO1 rs741301 variant associated with lower nephropathy risk (allelic odds ratio 0.77, 95% CI 0.67 to 0.88). Twenty haemodialysis patients, median age 78.4, given a single dose of the RSV vaccine Arexvy showed IgG unchanged at week five, rising at week eight, peaking at week 16 and still above baseline at week 32; matched controls responded within two weeks. Antibody levels fell with longer dialysis vintage. The FDA approved a supplement to Ajanta Pharma's generic dapagliflozin application on 2 September.