Difficulties in diagnosis and treatment of idiopathic cryoglobulinemic glomerulonephritis

Background. Cryoglobulinemic vasculitis (CV) is an immunocomplex vasculitis of small caliber vessels associated with cryoglobulins. Renal involvement occurs in 1/3 of patients, with clinical manifestations ranging from minimally expressed urinary syndrome to acute nephritic or nephrotic syndrome with signs of acute kidney injury (AKI). Immunosuppression is recommended for severe CV.

Objective. Demonstration of the difficulties in diagnosis and treatment of CV with renal damage.

Clinical case. Patient A., 57 years old woman. At the onset of the disease – nephrotic syndrome with signs of AKI, according to nephrobiopsy – diffuse proliferative glomerulonephritis typical for CV. Hemodialysis was performed, glucocorticoids and cyclophosphamide were administered without effect. Remission was achieved on the background of rituximab therapy.

Conclusion. Careful evaluation of all available data, including nephrobiopsy, is essential for the successful diagnosis of CV with renal involvement. Immunosuppressive therapy is recommended for severe idiopathic CV.