Abstract: FR-PO0772
A Case of Nephrotic Syndrome Due to Renal-Limited Cryoglobulinemic Vasculitis During Treatment of High-Grade B-Cell Lymphoma
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 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
- Abe, Erika, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
- Iwashita, Takatsugu, Saitama City Hospital, Saitama, Japan
- Ono, Yuko, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
- Maeshima, Akito, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
Introduction
Cryoglobulinemic vasculitis (CV) is an immune complex–mediated small-vessel vasculitis that can involve the kidneys, typically presenting as membranoproliferative glomerulonephritis (MPGN) pattern injury. It is commonly associated with hepatitis C virus infection, autoimmune diseases, or lymphoproliferative disorders. However, renal-limited CV associated with aggressive B-cell lymphoma is extremely rare.
Case Description
A 63-year-old woman presented with exertional dyspnea. Chest computed tomography revealed a 90 mm mass in the right pulmonary hilum, pleural effusion, and multiple lymphadenopathies. Cell block of the pleural effusion revealed the presence of CD10+, λ>>κ B-cell lymphoma, and lymph node biopsy led to a diagnosis of high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH). Two months after the initiation of chemotherapy, she developed proteinuria and hematuria, which progressed to nephrotic-range proteinuria. Serum immunoglobulin and complement levels were normal. Serological tests for autoimmune diseases, hepatitis C virus infection, and monoclonal gammopathy were negative. Serum cryoglobulin was weakly positive, but she had no extrarenal manifestations suggestive of systemic CV. Renal biopsy revealed MPGN pattern injury with marked subendothelial deposits and pseudothrombi. Immunofluorescence showed dominant deposition of IgM, λ light chain, and C4. Electron microscopy demonstrated electron-dense deposits with organized structures in the subendothelial space and capillary lumina. Waldenström macroglobulinemia was excluded based on the absence of IgM-type monoclonal protein and bone marrow tumor infiltration. These findings supported a diagnosis of kidney-limited cryoglobulinemic vasculitis associated with HGBL-DH/TH. After chemotherapy, complete metabolic remission was achieved in HGBL-DH/TH. Treatment with prednisolone and rituximab was initiated for nephrotic syndrome; however, nephrotic-range proteinuria persisted.
Discussion
This case represents an extremely rare presentation of renal-limited cryoglobulinemic vasculitis associated with HGBL-DH/TH. Notably, while many cases of CV secondary to B-cell lymphoma are known to be IgM-κ dominant, but this case was IgM-λ dominant. This suggests a possible pathogenic link between the preceding lymphoma and renal-limited immune complex deposition.