Anti-factor H antibody and its role in atypical hemolytic uremic syndrome

Front Immunol. 2022 Aug 23:13:931210. doi: 10.3389/fimmu.2022.931210. eCollection 2022.

Abstract

Atypical hemolytic uremic syndrome (aHUS) an important form of a thrombotic microangiopathy (TMA) that can frequently lead to acute kidney injury (AKI). An important subset of aHUS is the anti-factor H associated aHUS. This variant of aHUS can occur due to deletion of the complement factor H genes, CFHR1 and CFHR3, along with the presence of anti-factor H antibodies. However, it is a point of interest to note that not all patients with anti-factor H associated aHUS have a CFHR1/R3 deletion. Factor-H has a vital role in the regulation of the complement system, specifically the alternate pathway. Therefore, dysregulation of the complement system can lead to inflammatory or autoimmune diseases. Patients with this disease respond well to treatment with plasma exchange therapy along with Eculizumab and immunosuppressant therapy. Anti-factor H antibody associated aHUS has a certain genetic predilection therefore there is focus on further advancements in the diagnosis and management of this disease. In this article we discuss the baseline characteristics of patients with anti-factor H associated aHUS, their triggers, various treatment modalities and future perspectives.

Keywords: aHUS; anti-factor H antibody; atypical hemolytic uremic syndrome; factor H; pediatric.

MeSH terms

  • Acute Kidney Injury* / genetics
  • Acute Kidney Injury* / immunology
  • Acute Kidney Injury* / therapy
  • Antibodies / genetics
  • Antibodies / immunology
  • Atypical Hemolytic Uremic Syndrome* / complications
  • Atypical Hemolytic Uremic Syndrome* / genetics
  • Atypical Hemolytic Uremic Syndrome* / immunology
  • Atypical Hemolytic Uremic Syndrome* / therapy
  • Blood Proteins / genetics
  • Complement C3b Inactivator Proteins / genetics
  • Complement Factor H / antagonists & inhibitors
  • Complement Factor H / genetics
  • Complement Factor H / immunology
  • Complement System Proteins* / genetics
  • Complement System Proteins* / immunology
  • Humans
  • Plasma Exchange

Substances

  • Antibodies
  • Blood Proteins
  • CFHR1 protein, human
  • CFHR3 protein, human
  • Complement C3b Inactivator Proteins
  • Complement Factor H
  • Complement System Proteins