title: Rituximab treatment for a patient with type I cryoglobulinemic glomerulonephritis.
abstract: BACKGROUND
  A 74-year-old woman with a history of type I cryoglobulinemia with glomerulonephritis that had been successfully treated with plasmapheresis and cyclophosphamide approximately 9 years earlier presented with hemoptysis and mediastinal lymphadenopathy. Evaluation revealed the reappearance of cryoglobulins and nephrotic-range proteinuria. In addition, the patient's serum creatinine level, which had been stable for approximately 9 years after her first treatment, had increased from 79.2 micromol/l (0.9 mg/dl) to 281.6 micromol/l (3.2 mg/dl) over 6 months.
  
  
  METHODS
  Physical examination, serum and urine laboratory analyses, CT scan, mediastinoscopy with lymph node biopsy, bone marrow biopsy, flow cytometry analysis of bone marrow, peripheral blood and lymph node tissue, and percutaneous ultrasound-guided renal biopsy.
  
  
  METHODS
  Type I cryoglobulinemic glomerulonephritis associated with a CD20(+) lymphoid disorder.
  
  
  RESULTS
  One plasmapheresis treatment, one dose of cyclophosphamide, and four weekly cycles of rituximab.
authors.affiliation: Division of Nephrology in Department of Internal Medicine at Wayne State University School of Medicine, Detroit, MI 48201, USA.
authors.forename: Sushma
authors.initials: S
authors.lastname: Pandrangi
authors.forename: Atul
authors.initials: A
authors.lastname: Singh
authors.forename: Donald E
authors.initials: DE
authors.lastname: Wheeler
authors.forename: Noreen F
authors.initials: NF
authors.lastname: Rossi
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D001706:Biopsy; D003449:Cryoglobulinemia / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology; D008875:Middle Aged; D000069283:Rituximab; D012720:Severity of Illness Index
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab