Treatment of Primary Immune Complex MPGN in Adults Aged 18 Years or Older
Clinical Scenario
This protocol applies to adults aged 18 years or older with primary immune complex membranoproliferative glomerulonephritis (IC-MPGN), whether the affected kidney is native or post-transplant.
Treatment Approach
Management involves initiating a subcutaneous complement inhibitor therapy on top of continued supportive care. The complete regimen — including the specific agent and full dosing — is available in the structured protocol below.
Clinical Goals
Key targets include a significant reduction in proteinuria by week 26, stabilization of eGFR at 6 months, and reduced glomerular complement deposition on kidney biopsy at week 26.
References
- In 2025, pegcetacoplan was also approved by the US Food and Drug Administration for the treatment of adult and pediatric patients aged ≥ 12 years with C3G or primary IC-MPGN to reduce proteinuria.
- Pegcetacoplan is administered as a subcutaneous injection at a recommended dose of 1080 mg (in 20 ml) twice a week for adults using a commercially available infusion pump or on-body injector device, where available.
- The phase 3 trial data suggest that we should be using these agents in patients with significant proteinuria at the outset.
- Patients who achieve a UPCR < 0.88 g/g (< 100 mg/mmol) at 12 months after diagnosis benefit from a 90% lower risk of kidney failure than those who did not achieve this threshold.
- For both C3G and primary IC-MPGN, a ≥ 50% proteinuria reduction after 12 months has consistently been associated with significantly lower risk of kidney failure, as demonstrated by both the UK RaDaR and Spanish GLOSEN registries.
- Even stabilization of eGFR may be considered a success after 6 months of complement inhibitor therapy, although it must be acknowledged that changes in eGFR are dependent on factors such as disease chronicity.
DOI: 10.1016/j.ekir.2025.10.020
View source ↗