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Open Access Open Badges Case report

Juvenile elastic arteries after 28 years of renal replacement therapy in a patient with complete complement C4 deficiency

Florian Knoll1*, Emanuel Zitt13, Denis Intemann2 and Karl Lhotta13

Author Affiliations

1 Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Carinagasse 47, Feldkirch, 6800, Austria

2 Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria

3 Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Feldkirch, Austria

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BMC Nephrology 2012, 13:161  doi:10.1186/1471-2369-13-161

Published: 2 December 2012



Complement activation products are present in atherosclerotic plaques. Recently, binding of complement to elastin and collagen in the aortic wall has been demonstrated, suggesting a role of complement in the development aortic stiffness and atherosclerosis. The definitive role of complement in atherosclerosis and arteriosclerosis, however, remains unclear.

Case presentation

We here describe a patient with hereditary complete deficiency of complement C4 suffering from Henoch-Schoenlein purpura and on renal replacement therapy for twenty-eight years. The patient had the full range of risk factors for vascular damage such as hypertension, volume overload, hyperphosphatemia and hyperparathyroidism. Despite that, his carotid artery intima media thickness was below the normal range and his pulse wave velocity was normal. In contrast, the patient’s coronary and peripheral muscular arteries were heavily calcified.


This case supports the hypothesis that complement plays an important role in the development of stiffness of elastic arteries. We speculate that inability to activate complement by the classical or lectin pathways protected the patient from atherosclerosis, arteriosclerosis, stiffening and calcification of the aorta and carotid arteries. Inhibition of complement activation may be a potential target for prophylactic and therapeutic interventions.

Complement; Atherosclerosis; Arteriosclerosis; Renal replacement therapy