title: [Renal involvement during type 1 cryoglobulinemia].
abstract: Cryoglobulins are circulating immunoglobulins that precipitate with cold temperature and dissolve with rewarming. Type 1 cryoglobulinemia is composed of a single monoclonal immunoglobulin and is associated with renal involvement in up to 40% of cases. Type 1 cryoglobulinemia is related to an underlying B-cell haematological malignancy in 60% of patients. In the remaining cases, in the absence of criteria for malignancy, the diagnosis of monoclonal gammopathy of renal significance should be established. The clinical and biological setting and histological features of type 1 cryoglobulinemia are globally similar to those of mixed cryoglobulinemia. In case of haematological malignancy, the treatment is guided by the nature of the underlying disease, and aims at inducing haematological remission, which is necessary for the renal response. The management of monoclonal gammopathy of renal significance has been clarified by an international consensus group and is based on the nature of the underlying clone. In case of monoclonal cryoglobulinemia associated with a plasma-cell clone (IgG or IgA), the treatment is based on the combination of bortezomib, cyclophosphamide and dexamethasone. In case of IgM monoclonal cryoglobulinemia, the treatment is similar to that of Waldenström macroglobulinemia, and is based on rituximab. The clinical course of renal monoclonal cryoglobulinemia is intimately associated with the haematological response, and is usually favourable.
authors.affiliation: Service de néphrologie-transplantation adultes, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. Electronic address: mohamad.zaidan@hotmail.fr.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Zaidan
authors.affiliation: Service de néphrologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Centre national de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Plasse
authors.affiliation: Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Rabant
authors.affiliation: Service de néphrologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Centre national de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Javaugue
authors.affiliation: Service de néphrologie-transplantation adultes, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Knebelmann
authors.affiliation: Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service d'immunologie biologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: Marie-Alexandra
authors.initials: MA
authors.lastname: Alyanakian
authors.affiliation: Service de néphrologie-transplantation adultes, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Joly
authors.affiliation: Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service d'anatomie pathologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Nochy
authors.affiliation: Service de néphrologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Centre national de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Bridoux
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000069286:Bortezomib / Q000627:therapeutic use*; D003449:Cryoglobulinemia / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015432:Glomerulonephritis, Membranoproliferative / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005938:Glucocorticoids; D000069286:Bortezomib; D003907:Dexamethasone; D003520:Cyclophosphamide
keywords: Cryoglobulin; Cryoglobuline; Cryoglobulinémie de type 1; Cryoglobulinémie monoclonale; Gammapathie de signification rénale; Glomérulonéphrite membranoproliférative; Haematological malignancy; Hémopathie; Membranoproliferative glomerulonephritis; Monoclonal cryoglobulinemia; Monoclonal gammopathy of renal significance; Type 1 cryoglobulinemia