Treatment of the Renal Involvement in Mixed Cryoglobulinemia with Prolonged Plasma Exchange

Abstract

Nine patients with mixed cryoglobulinemia and severe membranoproliferative glomerulonephritis were treated with plasma exchange alone or in combination with medium to low amounts of corticosteroids, but never with cytotoxic drugs. In 5 patients renal function and/or proteinuria improved after plasma exchange, and no clinical relapse usually occurred when the procedures were reduced or discontinued. These procedures seemed of particular effect in the presence of histologically active and not irreversible lesions and rapid deterioration of renal function. While cryocrit almost invariably decreased, circulating immune complex or complement levels were unpredictably affected by plasma exchange. Cryocrit, but not immune complex or complement levels, was the serological parameter which most often closely correlated with signs of renal involvement (i.e., proteinuria and/or serum creatinine). Thus, plasma exchange might be a safe and useful tool in the treatment of an often drug-resistant and rapidly progressive renal involvement occurring in patients with mixed cryoglobulinemia.

Cryoglobulinemia Membranoproliferative Glomerulonephritis Associated with Hepatitis C Virus

“…Moreover, the presence of ge nomic sequences, indicating the ongoing HCV multiplication, was found in all sub jects investigated by PCR. Light microscopy, showing hypercellular lobulated glomeruli, thickened capillary walls and frequent 'dou ble contours', intraluminal thrombi and/or pseudothrombi, confirmed that renal in volvement of MC is invariably characterized by a type 1 MPGN [14], This is an immune complex glomerulonephritis that may in volve either classical or alternate pathways of complement activation. This is proved by the identification of complement compo nents (C3, C4, C lq) and immunoglobulins in glomerular basement membranes using the immunofluorescence technique and of electron-dense deposits in the subendothelial side, corresponding to immune complex deposition in the capillary walls, by electron microscopy [15].…”

Cryoglobulinemic vasculitis with renal involvement: A historic aspect of the problem

“…Затем на протяжении не-скольких десятилетий с этой целью назначались НПВП и глюко-кортикостероиды (ГКС) в низких дозах, а при тяжелом течении (гломерулонефрит, невропатия, системный васкулит) проводи-лась монотерапия в более высоких дозах или в комбинации с ци-тостатиками и/или экстракорпоральными методами (ПА, криоа-ферез), что остается стандартом лечения до последнего времени [23,24].…”

Clinical applications of therapeutic apheresis

“…Thus some patients are left with plasmapheresis as the only available therapeutic option or others may need plasmapheresis until these other therapies take hold. Ferri et al [30] showed that some patients with cryoglobulinemia may respond to plasmapheresis alone (Table III).…”