Abstract: TH-PO1160
Type 1 Cryoglobulinemic Glomerulonephritis with Vasculitis: Rapid Resolution of AKI with Treatment Aimed at Underlying Clonal Disorder
Session Information
- Onconephrology: Emerging Biomarkers, Preclinical Models, Clinical Challenges, and Therapeutic Strategies
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Schmidt, Patrik, New York University Grossman School of Medicine, New York, New York, United States
- Bailey, Ronelle, New York University Grossman School of Medicine, New York, New York, United States
- Khan, Saila Azam, New York University Grossman School of Medicine, New York, New York, United States
- Drakakis, James, New York University Grossman School of Medicine, New York, New York, United States
Introduction
Monoclonal gammopathy of renal significance (MGRS) is an entity by which a clone produces renal disease through deposition of secreted monoclonal immunoglobulin. Cryoglobulins are immunoglobulins that precipitate in cold conditions, and compositions heterogeneous, divided into 3 types. Type I is often seen with hematological malignancies. We report a case of acute kidney injury (AKI) requiring hemodialysis (HD) in setting of type I cryoglobulinemic glomerulonephritis with vasculitis and monotypic IgG kappa deposits. Treatment at first was aimed at vasculitis, then directed at underlying clonal disorder. This approach led to renal recovery and cessation of dialysis.
Case Description
78 year old male presented with painful lower extremity skin blistering. Serum creatinine rose from 2.7 mg/dL on admit to 5.0 mg/dL. UA had 3+ protein and 11-20 RBC. Serum complements both low. Serum immunofixation with faint band in IgG kappa. IgG 1832 mg/dL, serum free light chain ratio 1.21. HD initiated and kidney biopsy done. This revealed focal endocapillary proliferative glomerulonephritis, acute, immune pseudothrombi, small vessel vasculitis and monotypic IgG kappa deposits. Findings most consistent with type I cryoglobulinemic glomerulonephritis with vasculitis. Inpatient treatment included 5 sessions of plasma exchange, IV steroid pulse, followed by Prednisone 60 mg (tapered off two months later), IV Cyclophosphamide. Cr at hospital discharge 0.87 mg/dL.
Discussion
Our case of type I cryoglobulinemia with monoclonal gammopathy, highlights the importance of clone directed therapy even in absence of definite hematologic malignancy. It has been shown that severe manifestations can be similarly prevalent due to either underlying hematologic malignancy or non malignant monoclonal gammopathy. Factors that could discourage up front treatment with clone directed therapy include bone marrow (BM) biopsy without significant plasma cell clones and dialysis dependency. Here, while BM biopsy showed no abnormal findings, early initiation of treatment led to full renal recovery.
RLE Lesions