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Abstract: PO1863

Clinico-Biological Characteristics and Treatment of Hepatitis B Virus-Related Mixed Cryoglobulinemia: Current Clinical Evidence

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Tang, Wenbin, Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Wang, Xiufen, Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Ge, Huipeng, Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Deng, Tianci, Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Xiao, Xiangcheng, Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
Background

Hepatitis B virus(HBV)-related mixed cryoglobulinemia (MC) was considered to be a rare disease, presented as mild clinical symptoms just like purpura to severe organ damage such as glomerulonephritis. We aimed to clarify the clinico-biological characteristics and treatment of HBV-related MC.

Methods

We reported a case of HBV-related MC, enrolled 41 HBV-related MC cases from literature, and summarized demographic, clinical, laboratory, treatment and outcome data of the 42 HBV-related MC cases. Meanwhile, the Asian and European group, patients in remission and refractory were compared. Kidney involvement, death and time to death were included for survival analysis.

Results

Of the 42 HBV-related MC, Mean age was 53±14 years, and 47.6% patients were male. Extrahepatic clinical manifestations mainly included cutaneous lesions, kidney involvement, peripheral neuropathy, articular involvement, which accounted for 78.6%, 54.8%, 35.7%, 19.0%, respectively. 87.1% (27/31) patients had low serum C4, and 92.6% (25/27) patients’ rheumatoid factors(RF) were positive. Renal pathology showed membranous proliferative glomerulonephritis, the capillary lumen disclosed hyaline thrombi and electron microscope found microtubular substructure. 36 (85.7%) patients received antiviral therapy. Corticosteroids were used in 22 (52.4%) patients, immunosuppressive agents were given to 13 (31.0%) patients, and plasma exchange (PE) were used in 9 (21.4%) patients. At the end of follow-up, 52.4% (22/42) patients were in remission, 47.6% (20/42) patients had refractory disease, and 11.9% (5/42) patients died. The patients who had cutaneous necrosis, peripheral neuropathy and kidney involvement were more likely to have refractory disease but without statistical difference. The Asian group showed more kidney involvement than the European group (P=0.001), but the European group had more peripheral neuropathy (P=0.037). The Asian group showed a higher mortality than the European group(P=0.048). Univariate analysis showed kidney involvement had correlation with overall survival (log rank P=0.034).

Conclusion

Extrahepatic clinical manifestations of HBV-related MC were varied. Anti-HBV treatment, corticosteroids, immunosuppressive agents and PE were useful for some patients. The patients with kidney involvement may be related to poor prognosis.