title: A case report of recurrence of mixed cryoglobulinemic glomerulonephritis in a renal transplant recipient.
abstract: Recurrence of glomerulonephritis (GN) is one of the major risk factors of long-surviving renal graft dysfunction. Cryoglobulinemic glomerulonephritis of hepatitis-C virus (HCV)-negative patient is a rare cause of end-stage renal disease. There is little case report of recurrent cryoglobulinemic glomerulonephritis in negative HCV recipients after renal transplantation. We represent a renal allograft recipient of an interesting recurrent cryoglobulinemic glomerulonephritis. The patient was diagnosed with mixed cryoglobulinemic glomerulonephritis by kidney biopsy at the age of 32 . He had no HCV, HBV nor liver dysfunction. He received immunosuppressive therapy, however, was introduced to hemodialysis treatment after 13 yr. He received a cadaveric renal transplantation at the age of 50, and immunosuppressive treatment was started with ciclosporin, prednisolone and mycophenolate mofetil (MMF). Four yr after transplantation, he developed fever and purpura of lower limbs. His serum creatinine level did not increase, however, proteinuria, hematuria, hypocomplementemia, positive rheumatoid factor and mixed cryoglobulinemia were noted. Detailed analysis failed to reveal the composition of mixed cryoglobulinemia. The renal allograft biopsy showed membranoproliferative-type GN with monocyte and polynuclear leukocyte accumulation of capillary loops and small cellular crescent. Immunofluorescent study showed C3, IgG and IgM deposition of mesangial and capillary pattern. Regardless of steroid pulse therapy, hypocomplementemia and positive rheumatoid factor did not improve. Ten yr after transplantation, he was affected by cellulitis and sepsis. Afterward, rising of serum creatinine and nephrotic range proteinuria developed. The allograft biopsy revealed advanced cryoglobulinemic glomerulonephritis with characteristic vascular lesions. Electron microscopy showed organized subendothelial deposits compatible with cryoglobulinemic glomerulonephritis and proteinaceous thrombus in arteriole.
authors.affiliation: Kidney Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Takeda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ootsuka
authors.forename: Taisei
authors.initials: T
authors.lastname: Suzuki
authors.forename: Yukako
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Tsujita
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Keiji
authors.initials: K
authors.lastname: Horike
authors.forename: Tadashi
authors.initials: T
authors.lastname: Oikawa
authors.forename: Norihiko
authors.initials: N
authors.lastname: Goto
authors.forename: Takaharu
authors.initials: T
authors.lastname: Nagasaka
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watarai
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Uchida
authors.forename: Kunio
authors.initials: K
authors.lastname: Morozumi
mesh_terms: D000328:Adult; D003449:Cryoglobulinemia / Q000209:etiology* / Q000473:pathology; D005921:Glomerulonephritis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D012008:Recurrence
chemical_list: D007166:Immunosuppressive Agents