REVIEW  HEPATITIS C INFECTION: A SYSTEMIC DISEASE 

Minerva Medica 2021 April;112(2):162-74

DOI: 10.23736/S0026-4806.20.07076-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Cryoglobulinemic glomerulonephritis: clinical presentation and histological features, diagnostic pitfalls and controversies in the management. State of the art and the experience on a large monocentric cohort treated with B cell depletion therapy

Daniela ROSSI ¹, Savino SCIASCIA ¹, Roberta FENOGLIO ¹, Michela FERRO ¹, Simone BALDOVINO ¹, Joelle KAMGAING ¹, Federica VENTRELLA ¹, Ileana KALIKATZAROS ¹, Lucia VIZIELLO ¹, Laura SOLFIETTI ¹, Antonella BARRECA ^{1, 2}, Dario ROCCATELLO ¹ ✉

¹ Unit of Nephrology and Dialysis (ERKnet Member), Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hospital, University of Turin, Turin, Italy; ² Patology Division, A.O.U. Città della Salute e della Scienza, Turin, Italy

Cryoglobulinemia is defined by the presence of immunoglobulins having the following characteristics: forming a gel when temperature is <37 °C, precipitate in a reversible manner in the serum, and redissolve after rewarming. The presence of both polyclonal IgG and monoclonal IgM (type II), or of polyclonal IgG and polyclonal IgM (type III) identifies the mixed cryoglobulinemia (MC). The identification of the Hepatitis C virus (HCV) infection in most of the cases previously defined as “essential” represented a cornerstone in the understanding the pathogenesis of this condition. The picture of MC comprehends heterogeneous clinical presentations: from arthralgias, mild palpable purpura, fatigue to severe vasculitis features with skin necrotic pattern, peripheral neuropathy and, less commonly, lungs, central nervous system, gastrointestinal tract, and heart involvement. The kidney represents the most common organ presentation, and the presence of glomerulonephritis is a key element when considering prognosis. We discuss the clinical presentation and histological features, diagnostic pitfalls, and controversies in the management of patients with cryoglobulinemic glomerulonephritis, with a special focus on reporting our experience in treating patients with B cell depletion therapy.

KEY WORDS: Cryoglobulinemia; Rituximab; Hepatitis C