Kidney Week

Abstract: FR-PO900

Clinicopathological Study of Mixed Cryoglobulinemic Glomerulonephritis Caused by Non-Hepatitis C Virus Infection

Session Information

• Glomerular Diseases: Membranous Nephropathy, SLE, Complement
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Li, Chao, Peking Union Medical College Hospital, Beijing, China

Chao Li,

• Li, Hang, Peking Union Medical College Hospital, Beijing, China

Hang Li,

• Li, Xuemei, Peking Union Medical College Hospital, Beijing, China

Xuemei Li,

• Li, Xuewang, Peking Union Medical College Hospital, Beijing, China

Xuewang Li,

Background

To describe the clinical features, renal pathology findings and renal prognosis in patients with mixed cryoglobulinemic glomerulonephritis caused by non-hepatitis C virus infection.

Methods

This was a retrospective study including seven Chinese patients with non-HCV infection associated mixed cryoglobulinemic glomerulonephritis in a tertiary referral hospital from 2015 to 2018. The demographic, clinical, pathological characteristics, treatment and follow-up data were analyzed.

Results

Age at renal biopsy was 51±13 years, including five females and two males. 24hUP was 5.0±3.5g/d and three cases presented with nephrotic syndrome. The median baseline eGFR(CKD-EPI) was 40.5±15.8ml/min per 1.73m². The extrarenal manifestations were: purpura (n=6), arthralgia (n=2, 28.6%), peripheral neuropathy (n=1), cardiomyopathy (n=1). The etiologies of cryoglobulinemia were: HBV infection (n=4), Sjögren syndrome(n=2), essential(n=1). The median cryocrit was 4.9% (range4.0-5.0), rheumatoid factor was 567±153 IU/ml, C3 was 0.47g/L(range0.32-0.57), C4 was 0.003g/L(range0.001-0.013). Renal pathologic findings on light microscopy: endocapillary proliferative glomerulonephritis(n=4), membranoproliferative glomerulonephritis(n=3). Ultrastructural studies showed granular subendothelial electron-dense deposits in all patients and organized microtubules or fibrils were seen in three cases. Four patients with HBsAg positive receive antiviral medication. All patients were given corticosteroid, alone or combined with cyclophosphamide(n=5) or mycophenolate mofetil(n=1). One patient received plasmapheresis. The median follow-up time was 16 months (range 6-41). All patients survived, and no one progressed to ESRD. At endpoint of follow-up, 24hUP was 0.89g/d (range 0.17-2.0), and eGFR(CKD-EPI) was 72.6±21.2 ml/min per 1.73m².

Conclusion

Mixed cryoglobulinemic glomerulonephritis should be screened for non-HCV etiologies, especially in HBV-endemic country. Endocapillary proliferative glomerulonephritis was the common pathologic feature, as well as membranoproliferative glomerulonephritis. Early diagnosis and management of mixed cryoglobulinemic glomerulonephritis could benefit patients’renal outcome. Long-term prognosis should be investigated in further studies.