title: Multicenter study on hepatitis C virus-related cryoglobulinemic glomerulonephritis.
abstract: BACKGROUND
  Mixed cryoglobulinemia is a multisystem disorder associated strongly with hepatitis C virus (HCV) infection. The kidney frequently is involved, and glomerulonephritis represents the key factor affecting prognosis.
  
  
  METHODS
  Clinical, serological, immunogenetic, and morphological data were collected retrospectively from medical records of 146 patients with cryoglobulinemic glomerulonephritis who underwent biopsies in 25 Italian centers and 34 cryoglobulinemic controls without renal involvement.
  
  
  RESULTS
  Eighty-seven percent of patients were infected with HCV; genotype 1b was more frequent than genotype 2 (55% versus 43%). Diffuse membranoproliferative glomerulonephritis was the most prevalent histological pattern (83%). Type II cryoglobulin (immunoglobulin Mkappa [IgMkappa]/IgG) was detected in 74.4% of cases. The remainder had type III (polyclonal IgM/IgG) cryoglobulins. A multivariate Cox proportional hazard model showed that age, serum creatinine level, and proteinuria at the onset of renal disease were associated independently with risk for developing severe renal failure at follow-up. Overall survival at 10 years was about 80%. Kaplan-Meier survival curves were worsened by a basal creatinine value greater than 1.5 mg/dL (>133 mumol/L), but were unaffected by sex and HCV infection. Cardiovascular disease was the cause of death in more than 60% of patients.
  
  
  CONCLUSIONS
  Data confirm the close association between mixed cryoglobulinemia and HCV infection and between glomerulonephritis and type II cryoglobulin. Survival profiles are better than previously reported in the literature, probably because of improvement in therapeutic regimens. Causes of death reflect this improvement in survival, with an increased prevalence of cardiovascular events compared with infectious complications and hepatic failure, which were predominant in the past.
authors.affiliation: Centro Universitario di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Ospedale S.G. Bosco, Torino, Italy. dario.roccatello@unito.it
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fornasieri
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Giachino
authors.forename: Daniela
authors.initials: D
authors.lastname: Rossi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Beltrame
authors.forename: Giovanni
authors.initials: G
authors.lastname: Banfi
authors.forename: Roberto
authors.initials: R
authors.lastname: Confalonieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Tarantino
authors.forename: Sonia
authors.initials: S
authors.lastname: Pasquali
authors.forename: Antonio
authors.initials: A
authors.lastname: Amoroso
authors.forename: Silvana
authors.initials: S
authors.lastname: Savoldi
authors.forename: Valeriana
authors.initials: V
authors.lastname: Colombo
authors.forename: Carlo
authors.initials: C
authors.lastname: Manno
authors.forename: Antonio
authors.initials: A
authors.lastname: Ponzetto
authors.forename: Luigi
authors.initials: L
authors.lastname: Moriconi
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.forename: Roberto
authors.initials: R
authors.lastname: Rustichelli
authors.forename: Giovanni Barbiano
authors.initials: GB
authors.lastname: Di Belgiojoso
authors.forename: Chiara
authors.initials: C
authors.lastname: Comotti
authors.forename: Maria Ida
authors.initials: MI
authors.lastname: Quarenghi
mesh_terms: D000328:Adult; D000368:Aged; D003449:Cryoglobulinemia / Q000150:complications / Q000821:virology*; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000821:virology*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies