Abstract: SA-PO0691
A Diagnostic Conundrum: An Unusual Case of Cryoglobulinemic Glomerulonephritis in a Patient with Full-House Nephropathy
Session Information
- Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Park, Ji-Min, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Kanduri, Swetha Rani, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Gilani, Sarwat, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Introduction
Cryoglobulinemic glomerulonephritis (GN) is an immune complex-mediated disease often associated with infections, autoimmune disorders, or lymphoproliferative conditions. It can present with a wide spectrum of renal manifestations.
Case Description
A 66-year-old man presented with an acute kidney injury (AKI). Initial serum creatinine was 4.66 mg/dL, with no known history of chronic kidney disease. Further laboratory evaluation revealed elevated blood urea nitrogen (BUN) of 135 mg/dL and normal electrolytes.
Autoimmune serologies including antinuclear antibody (ANA), anti-double-stranded DNA, SS A/B antibodies, and anti-Smith antibodies were negative. Rheumatoid factor was positive at 7.29 units and C-reactive protein was elevated at 65.9 mg/L. Myeloperoxidase antibody (MPO) was negative and serine protease 3 (PR3) antibody was positive (3.4 AI). Complements C3 and C4 were low. Qualitative cryoglobulin results showed type III cryoglobulinemia with polyclonal IgG.
Urines studies showed nephrotic-range proteinuria (24-hour urine protein 4.8 g/g and urine protein-to-creatinine ratio 4.1 g/g), microscopic hematuria (>50 RBCs/HPF), pyuria (10-25 WBCs/HPF), and moderate bacteria although asymptomatic. Infectious workup showed evidence of prior hepatitis B infection (positive hepatitis B core antibody) with negative viral PCR, otherwise unremarkable (negative HIV, HCV, Anti-streptolysin O).
Renal ultrasound demonstrated normal-sized kidneys without hydronephrosis. Kidney biopsy showed immune complex-mediated GN with membranoproliferative features and focal crescentic lesions in the setting of type III cryoglobulinemia. These findings were most consistent with cryoglobulinemic GN, with overlapping features raising concern for full house nephropathy and ANCA associated injury. Patient was started on therapy with corticosteroids and plasma exchange followed by rituximab with clinical improvement.
Discussion
Cryoglobulinemic GN can present with overlapping features that complicate diagnostic classification. This case highlights cryoglobulinemic GN with coinciding features of full house nephropathy. Recognition of these atypical presentations is critical to guide appropriate therapy. This case emphasizes the importance of a comprehensive and multidisciplinary approach to immune complex-mediated kidney disease.