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Rituximab treatment for a patient with type I cryoglobulinemic glomerulonephritis

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From Nature Clinical Practice Nephrology

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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 µmol/l (0.9 mg/dl) to 281.6 µmol/l (3.2 mg/dl) over 6 months.

Investigations 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.

Diagnosis Type I cryoglobulinemic glomerulonephritis associated with a CD20+ lymphoid disorder.

Management One plasmapheresis treatment, one dose of cyclophosphamide, and four weekly cycles of rituximab.

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Figure 1: Histologic examination of the patient's first renal biopsy.
Figure 2: Changes in serum creatinine and cryoglobulin levels over the patient's clinical course.
Figure 3: Histologic examination of the patient's second renal biopsy.

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Authors and Affiliations

  1. A Singh is an Assistant Professor and NF Rossi is a Professor in the Division of Nephrology in the Department of Internal Medicine at Wayne State University School of Medicine, S Pandrangi is a Nephrology Fellow, Detroit, MI 48201, USA.,

    Sushma Pandrangi, Atul Singh & Noreen F Rossi

  2. DE Wheeler is Associate Professor of Pathology and Laboratory Medicine at the University of South Florida, Tampa, FL, USA.,

    Donald E Wheeler

Authors
  1. Sushma Pandrangi
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  2. Atul Singh
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  3. Donald E Wheeler
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  4. Noreen F Rossi
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Corresponding author

Correspondence to Noreen F Rossi.

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The authors declare no competing financial interests.

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Pandrangi, S., Singh, A., Wheeler, D. et al. Rituximab treatment for a patient with type I cryoglobulinemic glomerulonephritis. Nat Rev Nephrol 4, 393–397 (2008). https://doi.org/10.1038/ncpneph0823

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  • DOI: https://doi.org/10.1038/ncpneph0823

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