Abstract: TH-PO0870
Cryoglobulinemic Glomerulonephritis Without Hepatitis C: A Rare Case in the Setting of Autoimmune Hepatitis and Liver Transplant
Session Information
- Glomerular Case Reports: Potpourri
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Alfonso, Juan de Dios, Universidad Nacional de Cuyo Facultad de Ciencias Medicas, Mendoza, Mendoza Province, Argentina
- Nakhoul, Georges, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
- Ashour, Tarek, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
Introduction
Cryoglobulinemic glomerulonephritis (C-GN) is a severe complication of mixed cryoglobulinemia, which is usually associated with Hepatitis C. We present a patient with history of liver cirrhosis secondary to autoimmune hepatitis (AIH) who developed C-GN 5 years after liver transplantation.
Case Description
A 61-year-old female with past medical history of AIH status post liver transplantation and type 2 diabetes, presented to the emergency department with nausea, vomiting and abdominal pain. On physical examination, the patient had elevated blood pressure (180/84 mmHg), bilateral lower limb edema and bilateral fore-arm purpuric rash.
Evaluation revealed elevated creatinine of 3 mg/dL (from a baseline of 0.8 mg/dL, 3 months prior). Renal ultrasound showed no hydronephrosis. Urinalysis showed significant proteinuria (>300 mg/dl), pyuria (>25 WBCs/HPF) and >25 dysmorphic red blood cells/HPF, suggestive of glomerular involvement.
Serologic workup was negative for Hepatitis B, Hepatitis C, and HIV. Immunofixation was negative. C3 was 53 mg/dl (86 - 166 mg/dL) and C4 was 17 mg/dL (13 - 46 mg/dL). Cryoglobulin quantification was 321 ug/ml (0 - 50 ug/mL).
Kidney biopsy demonstrated a membranoproliferative glomerulonephritis with polyclonal deposits that was IgM dominant, suggestive of cryoglobulinemic glomerulonephritis. The patient previously had a liver allograft biopsy that showed persistent immune-mediated liver injury with early cirrhosis, so relapsed AIH was considered to be the etiology for the cryoglobulinemic vasculitis.
The patient was treated with pulse steroids with a further plan of immunosuppression with IV rituximab, however, given the poor performance status of the patient and advanced comorbidities she elected to change her hospital care to hospice.
Discussion
Mixed cryoglobulinemia is most commonly associated with Hepatitis C. Other known causes are autoimmune diseases and B cell lymphoproliferative disorders.
In our patient Hepatitis C was negative; however, she had history of AIH and evidence of recurrence in the liver allograft. Although there are few reported cases for patients who developed cryoglobulinemic glomerulonephritis related to AIH, none of them had liver transplant and negative Hepatitis C infection. Clinical suspicion followed by kidney biopsy is crucial to confirm the diagnosis.