geoscience.net logo
+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Clinical and morphologic spectrum of renal involvement in patients with mixed cryoglobulinemia without evidence of hepatitis C virus infection


, : Clinical and morphologic spectrum of renal involvement in patients with mixed cryoglobulinemia without evidence of hepatitis C virus infection. Medicine 88(6): 341-348

Hepatitis C virus (HCV) infection represents, by far, the major cause of mixed cryoglobulinemia (MC). The renal disease associated with this pathological condition is now well described. By contrast, renal involvement in patients with MC not associated with HCV has been only poorly described, and few cases have been reported. We analyzed the demographic, clinical, and laboratory features and outcome in patients presenting with renal disease associated with MC not related to HCV infection. Records of 20 patients with MC and renal disease, with no evidence of HCV by serology and polymerase chain reaction analysis, were retrospectively analyzed. Renal biopsies and extensive searches for lymphoproliferative disorder were performed in all patients at presentation. MC was related to primary Sjögren Syndrome (pSS) in 9 patients, and to non-Hodgkin lymphoma in 1 patient, while MC was classified as essential in the remaining 10 cases. Renal involvement was characterized by microscopic hematuria in all patients, nephrotic range proteinuria in 75% of patients, hypertension in 80% of patients, and renal failure in 85% of patients (mean glomerular filtration rate, 46 mL/min per 1.73 m). Membranoproliferative glomerulonephritis with subendothelial deposits was observed in all kidney specimens. Skin vasculitis was the main extrarenal manifestation. In all patients, cryoglobulinemia was classified as type II MC, characterized by monoclonal IgMkappa and polyclonal IgG. Most patients (17/20) were treated with steroids or immunosuppressive agents, or both. Initial renal remission was observed in 94% of patients. However, renal relapse occurred in most patients, with 10% reaching end-stage renal disease. Three patients with essential MC developed B-cell lymphoma 36-48 months after the diagnosis of MC. Unexpectedly, B-cell lymphoma induced by Epstein-Barr virus infection occurred in only 1 of the 9 pSS patients. Forty percent of patients died as a result of extrarenal causes.Renal disease associated with MC unrelated to HCV is characterized by the high prevalence of pSS (45%), the finding of CD20+ B-lymphocyte nodular infiltrates in the kidney interstitium, and a high incidence of overt B-cell lymphoma during follow-up. These findings emphasize the need for repetitive clinical evaluation in those patients.

US$19.90

PMID: 19910748

DOI: 10.1097/MD.0b013e3181c1750f


Other references

Krupinski, J.; Stroemer, P.; Slevin, M.; Marti, E.; Kumar, P.; Rubio, F., 2003: Three-dimensional structure and survival of newly formed blood vessels after focal cerebral ischemia. Penumbra tissue becomes highly angiogenic after ischaemic stroke in man, and the re-establishment of a functional vasculature might be beneficial to patients. Unilateral ischaemia was induced in male Sprague-Dawley rats by permanent occlusion of t...

Sou, W.I.; Chu, A.; Chiueh, P.T., 2016: Sustainability assessment and prioritisation of bottom ash management in Macao. NlmCategory="UNASSIGNED">In Macao, about 7200 t yr<sup>-1</sup> of bottom ash (BA) is generated and conventionally landfilled with construction waste. Because the properties of BA are similar to those of natural aggregates...

Park, C-Hun.; Park, H-Doo.; Lee, S-Youn.; Kim, J-Won.; Sohn, Y.Bae.; Park, S.Won.; Jin, D-Kyu., 2010: Clinical, biochemical, and genetic analysis of korean patients with pseudohypoparathyroidism type Ia. Pseudohypoparathyroidism (PHP) comprises a heterogeneous group of endocrine disorders with the common feature of resistance to parathormone (PTH), manifested by hypocalcemia, hyperphosphatemia, and elevation of serum PTH despite normal renal funct...

Schillaci, R.; Galeano, A.; Becu-Villalobos, D.; Spinelli, O.; Sapia, S.; Bezares, R.F., 2005: Autocrine/paracrine involvement of insulin-like growth factor-I and its receptor in chronic lymphocytic leukaemia. Chronic lymphocytic leukaemia (CLL) is characterized by the accumulation of long-lived B lymphocytes blocked in G(0/1) by impaired apoptosis. As insulin-like growth factor-I (IGF-I) is known for its antiapoptotic effects in different cell types, w...

Vertiev, I.V., 1987: Toxin-mediated causality of infectious diseases. Zhurnal Mikrobiologii, Epidemiologii, i Immunobiologii: 86-93

Sarvazyan, N.A.; Remmers, A.E.; Neubig, R.R., 1998: Determinants of Gi1a and bc binding. Measuring high affinity interactions in a lipid environment using flow cytometry. The Journal of Biological Chemistry 273(14): 34-40

Mokeeva V.L.; Galimova L.M.; Chaika M.N., 1988: Ultrastructure of the basidiospore cell wall in some amanita amanitopsis and pluteus species. The ultrathin structure of basidiospore cell wall in 7 species of Amanita genus [Aminita-muscaria, A. pantherina, A. phalloides, A. rubescens, A. virosa, A. citrina and A. porphyria], 3 species and one intermediate form of Amanitopsis genus [Amani...

Mittelman A.; Krown S.E.; Cirrincione C.; Safai B.; Oettgen H.F.; Koziner B., 1983: Analysis of t cell subsets in cancer patients with interferon. T cell subsets were analyzed in 33 patients with advanced cancer who were treated with either of 2 interferon preparations: a partially purified human leukocyte interferon (HulFN-.alpha.(Le)) and a highly purified recombinant interferon (IFLrA). I...

Varsanofyeva, V.A., 1957: Forty years of Soviet geology. Bulletin de la Societe des Naturalistes de Moscou Geol, 32(5): 5-54

Anonymous, 2002: Case IH AFX rotor 'most advanced design in combine technology. Southwest Farm Press 29(23): 18