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Kidney Week

Abstract: SA-PO863

Complex Clinical Interplay: A Case of Systemic Lupus Erythematosus Coexisting with Type II Cryoglobulinemia

Session Information

Category: Glomerular Diseases

  • 1401 Glomerular Diseases: From Inflammation to Fibrosis

Authors

  • Ladines, Madison M., Medical University of South Carolina, Charleston, South Carolina, United States
  • Vilayet, Salem, Medical University of South Carolina, Charleston, South Carolina, United States
  • ElSheikhMohammed, Waleed A., Medical University of South Carolina, Charleston, South Carolina, United States
  • Fulop, Tibor, Medical University of South Carolina, Charleston, South Carolina, United States
Introduction

The coexistence of Systemic Lupus Erythematosus (SLE) and cryoglobulinemia, characterized by the presence of cryoglobulins in the serum, represents a rare and challenging clinical scenario. This report highlights a case of a 32-year-old female with both conditions, presenting with acute kidney injury.

Case Description

A 32-year-old African American female with SLE and Type II cryoglobulinemia presented with severe shortness of breath, kidney failure, and pericardial effusion. Initial lab work revealed acute kidney injury (creatinine: 0.6 mg/dL to 2 mg/dL in 3 weeks). Treatment included azathioprine, prednisone, and hydroxychloroquine (methotrexate discontinued due to transaminitis). Her condition deteriorated with increased shortness of breath and hemoptysis. Lab findings: positive antinuclear antibodies, kappa-restricted IgM monoclonal protein (Type II cryoglobulin with monoclonal IgM kappa and polyclonal IgG), negative hepatitis panel, and red blood cells in urine. Kidney biopsy showed hyaline pseudo-thrombi and subendothelial/mesangial deposits on electron microscopy. Subsequently treated with therapeutic plasma exchange and cyclophosphamide infusions. Discharged with a stable creatinine level (0.9 mg/dL) on rituximab, hydroxychloroquine, and prednisone.

Discussion

The intersection of SLE and Type II Cryoglobulinemia presents a complex clinical picture with multiple implications. While studies suggest that cryoglobulinemia in SLE patients does not necessarily correlate with severe complications unless coupled with cryoglobulinemic vasculitis, our patient developed biopsy-proven lupus cryoglobulinemic glomerulonephritis, indicating systemic involvement. This case underscores the critical need for kidney biopsy in lupus management to target therapy for optimal outcomes.

Figure 1: Electron Microscopy of glomeruli notable for subendothelial and mesangial deposits.