Kidney Week

Abstract: SA-PO0745

Type II Cryoglobulinemic Glomerulonephritis Presenting with Near Full-House Immunofluorescence

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

• Gullulu Boz, Saide Elif, TC Saglik Bakanligi SBU Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Bursa, Turkey

Saide Elif Gullulu Boz, MD

• Karatutlu, Asena Serap, TC Saglik Bakanligi SBU Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Bursa, Turkey

Asena Serap Karatutlu, MD

• Kahvecioglu, Serdar, TC Saglik Bakanligi SBU Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Bursa, Turkey

Serdar Kahvecioglu, MD, DrMed

• Akarsu, Ozger, TC Saglik Bakanligi SBU Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Bursa, Turkey

Ozger Akarsu, MD

• Ozer Sensoy, Nazife Nur, TC Saglik Bakanligi SBU Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Bursa, Turkey

Nazife Nur Ozer Sensoy, DrMed

• Aktas, Nimet, TC Saglik Bakanligi SBU Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi, Bursa, Turkey

Nimet Aktas, MD

Introduction

Cryoglobulinemic vasculitis is an immune-complex disorder that may rarely present with atypical immunofluorescence patterns creating diagnostic challenges.

Case Description

A 75-year-old woman with hypertension and type 2 diabetes mellitus initially presented with cough, hemoptysis and dyspnea and received ceftriaxone for presumed pneumonia. Two weeks later, she developed palpable purpura, oliguria and rapidly progressive kidney injury. Creatinine increased from 0.7 to 3.2 mg/dL with nephritic urinary sediment. Examination revealed asymmetric sensorimotor polyneuropathy and ocular vasculitic involvement.
Laboratory evaluation demonstrated low C3 and C4, positive rheumatoid factor, and biclonal IgM paraproteinemia. ANA, ANCA and hepatitis serologies were negative. Serum cryoglobulin testing was negative but obtained after initiation of therapy.
Kidney biopsy demonstrated diffuse membranoproliferative glomerulonephritis with immune-complex deposition. Immunofluorescence microscopy showed dominant IgM staining with kappa light-chain predominance and positivity for all immunoglobulins and complement components except IgA and lambda light chain, producing a near full-house pattern.
Pulse corticosteroid therapy was initiated immediately after kidney biopsy because of anuric rapidly progressive kidney injury. The patient demonstrated dramatic recovery of urine output and renal function following corticosteroid therapy. Rituximab was subsequently added after biopsy findings supported cryoglobulinemic glomerulonephritis, resulting in a discharge serum creatinine of 0.9 mg/dL.

Discussion

This case highlights the diagnostic challenge of distinguishing cryoglobulinemic glomerulonephritis from other causes of immune-complex kidney injury. The differential diagnosis initially included ANCA-associated vasculitis, postinfectious glomerulonephritis and drug-induced tubulointerstitial nephritis following ceftriaxone exposure. However, biopsy findings, hypocomplementemia, rheumatoid factor positivity, and biclonal IgM paraproteinemia supported cryoglobulinemic vasculitis.
The near full-house immunofluorescence pattern mimicked lupus nephritis, although negative ANA serology and biclonal IgM paraproteinemia argued against lupus. Negative serum cryoglobulin testing did not exclude the diagnosis. Early biopsy-guided immunosuppressive therapy resulted in dramatic renal recovery and clinical stabilization.