CHSU Discovery

Introduction: Cryoglobulinemia-associated glomerulonephritis is a rare renal manifestation characterized by the deposition of cryoglobulins within glomerular structures, leading to immune-mediated glomerular injury. It often occurs in the setting of underlying systemic diseases, particularly hepatitis C virus (HCV) infection, but can also arise in the context of other autoimmune or lymphoproliferative disorders. While hepatitis C virus (HCV) infection is a well-established cause of cryoglobulinemia, cases unrelated to HCV are less common and pose diagnostic and management challenges. Membranoproliferative glomerulonephritis is more common in mixed cryoglobulinemia, and variations in underlying etiology likely account for the wide variation in the reported incidence of renal disease among various case series (5 to 60 percent). 

Conclusion: Nephrologist and Rheumatologist were consulted. Initiation of corticosteroids and restarting hydroxychloroquine to potentially modify the autoimmune process and alleviate systemic symptoms associated with Sjögren’s syndrome. Initiation of dialysis due to the worsening renal function. After 3-5 days, Patient improved with steroid therapy and the resolution of uremic symptoms, continuation of steroids and diminishing the immediate need for further dialysis was recommended. Rituximab, a monoclonal antibody targeting B cells, was discussed as a potential therapeutic option if the patient's condition deteriorated. Patient was discharged on day 12 with continue corticosteroid and Plaquenil and advised to follow up at AH Hanford Residency clinic and continue follow up with Nephrologist and Rheumatologist as scheduled.