Cryofiltration and Oral Corticosteroids Provide Successful Treatment for an Elderly Patient with Cryoglobulinemic Glomerulonephritis Associated with Hepatitis C Virus Infection.

Abstract

A 75-year-old manwas admitted due to nephrotic syndrome, purpura on the legs, which was associated with hepatitis C virus (HCV), and type II mixed cryoglobulinemia. Renal biopsy revealed features of cryoglobulinemic glomerulonephritis. Since the patient was elderly and the HCV genotype was Ib, interferon-alpha for reducing HCVwas not indicated. Four sessions of cryofiltration and the administration of corticosteroids improved the proteinuria and renal function strikingly without adverse effects. This case demonstrates that an elderly patient who has nephrotic syndrome caused by cryoglobulinemic glomerulonephritis associated with HCVcan be treated safely by cryofiltration with low doses of oral corticosteroids.

Purpura with Ulcerative Skin Lesions and Mixed Cryoglobulinemia in a Quiescent Hepatitis B Virus Carrier

“…The monotherapeutic cryofiltration performed in the current patient did not improve her deteriorated renal function, which should be related to her cryoglobulinemic glomerular injuries (4,28); however, it did seem to have at least some benefit for the cutaneous lesions. Nevertheless, the significant reduction in the serum IgG level confirmed in our patient during treatment with cryofiltration, which has been linked to a significant risk of various types of infections (29), led us switch to PEX, since FFP supplies normal plasma constituents, including globulins, that can induce beneficial immunomodulatory effects, such as alterations in the idiotype/anti-idiotype antibody balance (30).…”

“…There have been several reports demonstrating the therapeutic benefits of plasmapheresis in subjects with cryoglobulinemic vasculitis (2,5,17,28). The monotherapeutic cryofiltration performed in the current patient did not improve her deteriorated renal function, which should be related to her cryoglobulinemic glomerular injuries (4,28); however, it did seem to have at least some benefit for the cutaneous lesions.…”

Case of membranoproliferative glomerulonephritis due to essential cryoglobulinemia without hepatitis C virus infection

“…MPGN are associated with a number of other diseases including cryoglobulinemia. The clinical features of patients with mixed cryoglobulinemia typically include skin lesions including purpura, Raynaud's phenomenon, arthralgia, liver and renal disease 11,12,19 . Brouet et al .…”

Efficacy of Cryofiltration for Treatment of Mixed Cryoglobulinemia: A Report of Four Cases

“…We have successfully treated four cases suffering from severe and progressive manifestations of cryoglobulinemic vasculitis, in which cryofiltration was safe and effective in conjunction with immunosuppressive therapies and antiviral therapies. It been applied for the treatment of cryoglobulinemic vasculitis . Three of the cases had cryoglobulinemia secondary to HCV infection.…”

“…Then remaining plasma is warmed and returned to the patient. Although its efficacy has not yet been well established, it has been applied for the treatment of cryoglobulinemic vasculitis . Here we report four cases with mixed cryoglobulinemia showing severe and progressive clinical manifestations undergoing cryofiltration treatment.…”