Renal Involvement and HBV Infection Are Common in Chinese Patients With Cryoglobulinemia

Abstract

Objectives: This study aimed to describe the main characteristics of Chinese patients with cryoglobulinemia, especially the characteristics of patients with different causes of cryoglobulinemia.Methods: Eighty inpatients diagnosed with cryoglobulinemia from different wards in Peking Union Medical College Hospital were included in this study. Demographic, clinical, biological, and renal pathological data were collected. We analyzed the characteristics of 61 patients with different causes of cryoglobulinemia.Results: Most patients (36/80, 45%) were diagnosed between 40 and 60 years of age. The male: female ratio was 1:1.5. Mixed (II + III) cryoglobulinemia accounted for the majority (43.8%) of cases. Renal involvement (87.5%), cutaneous involvement (57.5%), and fever (27.5%) were the most common clinical manifestations, while other manifestations included serositis and pulmonary and gastrointestinal involvement. The most common renal histopathological pattern was membranoproliferative glomerulonephritis (25/42, 59.5%). The secondary causes of cryoglobulinemia included infectious diseases (26/61, 32.5%), such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and connective tissue diseases (22/61, 27.5%), such as lupus and hematologic tumors (13/61, 16.3%). Patients with hematologic tumors were diagnosed at an older age (P = 0.044) and mostly had type I cryoglobulinemia (P < 0.001). No significant difference in clinical or biological manifestations was found among patients with different causes of cryoglobulinemia.Conclusions: This is the largest cohort of Chinese patients with cryoglobulinemia. We found that renal involvement and HBV infection might be more common in Chinese patients with cryoglobulinemia.

Hepatitis B virus-associated cryoglobulinaemia diffuse endocapillary proliferative glomerulonephritis: a case report and literature review

“…Other biological features include cryoglobulin type, anaemia, thrombocytopenia, leukopenia, hypocomplementaemia, hyperglobulinaemia and rheumatoid factor positivity. 7 Cryoglobulinaemia can manifest as fatigue, purpura, and joint pain, and can involve the kidneys and peripheral nervous system. 8 Type II and mixed cryoglobulinaemia are seen mainly in HCV infections and autoimmune diseases.…”

“… 12 Studies at different centres in China have focused on HBV-associated cryoglobulinaemia, 13 , 14 especially cases with renal involvement. 7 Some research has reported that the HBV-infection rate in patients with cryoglobulinaemia may be equal to or greater than the HCV-infection rate. 15 Antiviral nucleoside analogues, including entecavir, adefovir dipivoxil and lamivudine, are safe and effective for treating patients with HBV-associated cryoglobulinaemia vasculitis.…”

“…The typical pathological type of cryoglobulinaemia glomerulonephritis is MPGN or membranous nephropathy, which is usually characterized by type I MPGN dominated by IgM deposition. 7 Mesangial proliferative glomerulonephritis, membranous nephropathy, focal segmental glomerulosclerosis, fibrous or immunotactoid glomerulopathy, and thrombotic microvascular disease have also been reported. 18 , 19 Some authors think that the affinity of circulating IgM κ for the mesangium is important in the deposition of mixed cryoglobulinaemia in the glomerulus and causes systemic damage.…”

Hepatitis B Virus Infection and Extra-Hepatic Manifestations: A Systemic Disease

“…In studies from Europe (mainly France and Italy), cryoVas can develop in 1%-4% of patients with HBV infection (48)(49)(50)(51)(52)(53). HBV infection might be more common in Chinese patients with cryoglobulinemia (54). The presentation of HBV-associated Cry-oVas had no peculiarity, and patients showed purpura (100%), arthralgia (71%), peripheral neuropathy (29%), GN (18%), and MC type 2/type 3 (88%/12%) (49).…”

“…Recently, several reports from China showed that renal involvement and HBV infection were common in Chinese patients with cryoglobulinemia (70,71). Although HBV-associated GN decreased over the past decade thanks to HBV vaccine campaign, it remains an important issue in endemic countries for HBV infection as China (72).…”