Long-term predictors of survival in essential mixed cryoglobulinemic glomerulonephritis

Abstract

We report the clinical outcome of 105 essential mixed cryoglobulinemia (EMC) patients with renal involvement collected throughout 25 years in three renal Units of Milan. The median follow-up was 72 months since renal biopsy and 131 months since the clinical onset of EMC. Patient survival was 49% at 10 years after renal biopsy. Forty-two patients died primarily from cardiovascular and liver disease or infection, whereas 15 patients developed chronic renal failure. Two patients had a complete remission of the disease while 15 had a remission only of renal signs. Thirty-one patients are alive with persistent renal and extrarenal manifestations. Anti-HCV antibodies were retrospectively detected in 34 patients and were present in 85% of them. This variable was not included in the statistical evaluation. At multivariate analysis, age older than 50 years, purpura, splenomegaly, cryocrit levels higher than 10%, C3 plasma levels lower than 54 mg/dl, and serum creatinine higher than 1.5 mg/dl were independent risk factors for death or dialysis. In conclusion, several factors may influence the outcome of patients with EMC nephritis. Markers of disease activity and an impaired renal function can herald a bad prognosis. It should be stressed, however, that only a minority of patients eventually develop renal failure, probably because in the most severe cases patients die earlier.

Chronic hepatitis C virus infection: Prevalence of extrahepatic manifestations and association with cryoglobulinemia in Bulgarian patients

“…In 55% of these patients, the findings include mild proteinuria, mild microscopic hematuria and mild renal insuffiency [45,46] . Arterial hypertension is present in 80% patients [45,47] . In the present study, 34 of the 136 HCV patents (25%) had mild proteinuria, hypertension and serum creatinine levels above the upper limit of normal.…”

Hepatotropic Viral Infection Associated Systemic Vasculitides—Hepatitis B Virus Associated Polyarteritis Nodosa and Hepatitis C Virus Associated Cryoglobulinemic Vasculitis

“…54 Upto 14% patients with develop chronic renal failure after a mean follow up of six years. 55 Pulmonary and gastrointestinal involvement are less common. 56,57 …”

Systemic abnormalities in liver disease

“…The prevalence of MPGN in patients with HCV infection is higher than that of patients with HBV infection [123] . A high incidence of mixed cryoglobulinemia (35%-90%) has been reported in patients with HCV infection [132][133][134] . Mixed cryoglobulinemia is a systemic vasculitis and can frequently cause renal disease.…”