Cryoglobulinemia and glomerular rhomboid inclusions in a child with acute kidney injury.
Cryoglobulinemia is rarely reported in children, and kidney failure secondary to cryoglobulinemia is even more uncommon. We report the case of a 7-year-old boy with cryoglobulins and a systemic illness, including persistent fever, arthralgias, rash, hypocomplementemia, and acute kidney injury associated with nephritic urine sediment. An extensive workup showed no infectious, neoplastic, or rheumatological cause of his kidney injury. The kidney biopsy specimen showed membranoproliferative glomerulonephritis type 1 with electron microscopic evidence of rhomboid crystalloid inclusions. These inclusions have rarely been reported in adult patients with cryoglobulinemia. The patient underwent spontaneous remission, including full recovery of kidney function, and required no immune suppression. The patient's course is consistent with cryoglobulinemia-associated kidney injury, which supports the inclusion of essential cryoglobulinemia in the differential diagnosis of pediatric patients with hypocomplementemic glomerulonephritis.
Nester
Carla M
CM
Department of Internal Medicine and Pediatrics, Divisions of Nephrology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1081, USA. carla-nester@uiowa.edu
Benner
Eric J
EJ
Latour
Mathieu
M
Nickeleit
Volker
V
Hamrick
Harvey
H
Primack
William
W
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D002648:Child; D003165:Complement System Proteins / Q000378:metabolism; D003449:Cryoglobulinemia / Q000097:blood / Q000150:complications* / Q000473:pathology; D003937:Diagnosis, Differential; D015432:Glomerulonephritis, Membranoproliferative / Q000097:blood / Q000150:complications / Q000473:pathology; D006801:Humans; D007678:Kidney Glomerulus / Q000648:ultrastructure*; D008297:Male; D008854:Microscopy, Electron
D003165:Complement System Proteins