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?