Kidney nontumor
Associated with systemic conditions
Cryoglobulinemia

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 21 March 2018, last major update September 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Cryoglobulinemia [title] kidney pathology

Cite this page: Sangle, N. Cryoglobulinemia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneycryoglobulinemia.html. Accessed October 16th, 2018.
Definition / general
  • Usually systemic disease in which deposits of IgG or IgM immune complexes cause glomerulonephritis (focal, diffuse), cutaneous vasculitis (skin rash) and synovitis (arthritis)
  • Defined by presence of serum cryoglobulins, which are immunoglobulin complexes that precipitate at 4°C and become soluble again at 30°C
  • Type I: cryoglobulin is single monoclonal immunoglobulin class, usually due to myeloma, Waldenström macroglobulinemia or other lymphoma
  • Type II: mixture of 2+ immunoglobulins, one a monoclonal antibody against polyclonal IgG; usually IgG-IgM, in which IgM is monoclonal and has rheumatoid factor activity
  • Type III: both immunoglobulin components are usually polyclonal IgG and IgM
Clinical features
  • Symptoms of fatigue, purpura over lower extremities, arthralgias, hepatosplenomegaly, lymphadenopathy, Raynaud phenomenon, glomerulonephritis in 50% with proteinuria and hypertension, progressing to renal failure in 5%
  • Usually women ages 30+ years
  • Hepatitis C virus is major cause of mixed cryoglobulinemia
  • Renal disease unrelated to Hepatitis C is often related to primary Sjögren Syndrome (Medicine (Baltimore) 2009;88:341)
  • Cryoglobulinemia found in 83% of chronic hemodialysis patients, although not necessarily symptomatic (Ren Fail 2011;33:801)
  • Types II and III associated with B cell lymphoma, chronic infection, chronic liver disease, SLE and hepatitis C
Case reports
Treatment
Microscopic (histologic) description
  • Expanded mesangium with thickened capillaries
  • Diffuse proliferative glomerulonephritis, often with membranoproliferative pattern
  • Also focal and segmental glomerulonephritis and less often crescentic or membranous glomerulonephritis
  • Acutely may produce wire loops or thrombi seen in lupus nephritis, vasculitis of interlobular arteries and afferent arterioles
Microscopic (histologic) images

Images hosted on other servers:

Cryoglobulin related glomerulonephritis - various images

Immunofluorescence
  • Immunoglobulins, strong C3; also C1q and C4
Electron microscopy description
  • Large amounts of subendothelial immune complex deposits; lesser amounts of subendothelial deposits
  • 50% have glomerular deposits with 25 - 35 nm microtubules forming bundles or arranged in fingerprint-like array
Electron microscopy images

Images hosted on other servers:

Various images

Differential diagnosis