Kidney Week

Abstract: TH-PO510

Renal Tubulointerstitial Injury in Patients With Cryoglobulinemia

Session Information

• Glomerular Diseases: Clinical, Outcomes, Trials - I
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

• Minting, Chen, Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Chen Minting,

• Shi, Xiaoxiao, Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Xiaoxiao Shi,

• Wen, Yubing, Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Yubing Wen,

• Xia, Peng, Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Peng Xia,

• Li, Xuemei, Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Xuemei Li,

• Chen, Limeng, Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

Limeng Chen,

Background

Kidney tubulointerstitial (TI) involvement in patients with cryoglobulinemia (CG-TI) was rare and their clinicopathological characteristics and renal prognosis remain unclear.

Methods

We recruited 199 inpatients with CG in our hospital. A total of nine cases of CG-TI were identified based on the tubular dysfunctions or TI injuries in kidney pathology. Their medical document, kidney pathology, treatment regimens, and follow-up data were reviewed and analyzed.

Results

The nine CG-TI patients had a median age at diagnosis of 49 (43-60) years with the male (44%). The primary causes of CG were primary Sjogren’s syndrome (33.3%) and monoclonal gammopathy of renal significance (22.2%). Mixed (II + III) cryoglobulinemia accounted for the majority (88.9%). The anemia (66.7%), fever (55.6%), and cutaneous lesions (33.3%) were the most common extrarenal manifestations. The mean eGFR level was 40.04 ml/min/1.73m². About 88.9% had proteinuria with a mean urine protein level of 1.01 g/d. Two patients had prominent proximal tubular injuries, presenting as Fanconi syndrome. Besides the cryoglobulinemic glomerulonephritis (GN) with a membranoproliferative GN, kidney pathology showed obvious tubulointerstitial injuries, with interstitial inflammatory infiltrates, tubular atrophy, and interstitial fibrosis. Intracapillary deposits were the short fibrillary substructure by electron microscopy. Seven patients received immunosuppressive treatment or chemotherapy. Followed the mean of 30±4 months, their renal function recovered within a year and stabilized thereafter.

Conclusion

We reported the rare cases series of CG-TI, which responded well to immunosuppressive treatment or chemotherapy.