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  Monday, 18 February 2013
  2 Replies
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Dear Experts: Treatment of mixed cryoglobulinemia causing proliferative GN and renal failure with Steroid/Rituximab/Plasmaphresis has been tried with some success ( plus treating the underlying disease), however the therapy for type 1 cryoglobulinemia causing proliferative GN and acute renal failure is not that clear (except the fact that underlying plasma cell disorder needs to be treated).  Case: ARF on dialysis with nephrotic presentation initially. Kidney biopsy: proliferative GN suggestive of cryoglobulinemia, IgM kappa . ? monoclonal cryoglobulin. SPEP/UPEP negative. C3/C4 low. Awaiting bone marrow biopsy. serum cryoglobulin negative but rheumatoid factor positive. Does anybody treat with Steroid/Rituximab/Plasma exchange, if by any chance this is truely type 1 .  How is the assay for cryoglobulinemia in Toronto. Do you have high rate of false negative there?
11 years ago

Usually, proliferative GN as a result of cryoglobulinemia is seen in mixed types I and II. The fact that rheumatoid factor was also positive is supportive of mixed type II or III. Type I leads to renal dysfunction on the basis of increase viscosity and thormbosis in the renal vasculature. Where as Types II/III cause immune complex GN. Is your question in reference to Type I or II/III?

Dr. Jordan Weinstein
11 years ago
It still sounds to me to be much more in-keeping with Types II/II (immune complex GN on biopsy, rheumatoid factor). Recall there would be a monoclonal portion of the cryoglobulin in Types II which has the rheumatoid factor activity. It is very common for the cryo assay in blood to falsely negative as it has to be transported on a warmed medium, and often it is not.
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