Abstract: SA-PO0735
Cryoglobulinemic Glomerulonephritis in a Patient with Treated Hepatitis C
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
- Shah, Anjuli, University of Michigan, Ann Arbor, Michigan, United States
- Bailoor, Kunal, University of Michigan, Ann Arbor, Michigan, United States
- Farkash, Evan A., University of Michigan, Ann Arbor, Michigan, United States
Introduction
Cryoglobulinemic glomerulonephritis is a renal manifestation of cryoglobulinemia associated with active hepatitis C and autoimmune disorders. We present a case of cryoglobulinemic glomerulonephritis in a patient who had been treated for hepatitis C fourteen years prior to presentation with sustained virologic response.
Case Description
A 71-year-old female with a history of hypertension, pancytopenia, hepatitis C treated in 2012 with sustained virologic response, and CKD IIIa was admitted to the hospital for an AKI in February 2026. In 2025, a skin biopsy of a rash on her thighs revealed leukoclastic vasculitis. Creatinine was 2.04 from a baseline of 1.20. Urinalysis was positive for blood, and urine microscopy showed acanthocytes. Type II cryoglobulins were positive, and she had hypocomplementemia. She was negative for ANA and anti-dsDNA. Her hepatitis C antibody was positive but her PCR was negative. She underwent a renal biopsy which showed immune complex glomerulonephritis with pseudothrombi on light microscopy and curvilinear substructure on electron microscopy. There was extensive glomerular involvement including frequent crescents, necrosis and tubuloreticular inclusions. She was negative for malignancy on a whole body PET. She was treated with 1g of IV solumedrol for three days, however her creatinine increased from 2.98 to 3.37. She underwent three sessions of PLEX that resulted in a decrease in creatinine to 1.64. She was given a 1g dose of rituximab and discharged with a prednisone taper and plans for a second dose of rituximab. Her creatinine returned to 1.44, and she has not had a recurrence of her rash.
Discussion
Cryoglobulinemic GN is generally associated with active replicating hepatitis C, but we present a case where cryoglobulinemic GN presented years after successful treatment. While SLE was on the differential based on deposits in multiple glomerular subcompartments and a full-house pattern by immunofluorescence, electron microscopy denoting the presence of curvilinear substructure rather than a fingerprint substructure was diagnostic for cryoglobulinemic glomerulonephritis.
Left: Pseudothrombi and crescent
Right: Curvilinear deposits