Crioglobulinemia mixta asociada a virus de la hepatitis C: Diagnóstico mediante biopsia renal transyugular

Maya, Mar Lozano; Martinez, Maria; Bañares, Rafael; Barreto, Ismael Yepes; Díaz, Ángel Ponferrada; Benítez, Patrocinio Rodríguez; Rasche, E. Niembro de; Arregui, E. Cos

doi:10.4321/s1130-01082009000900014

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“…A total of 279 patients (30 from our department and 249 from the literature search) 2 – 9 , 11 , 12 , 15 – 19 , 24 , 25 , 27 , 32 , 33 , 35 , 36 , 38 , 39 , 42 – 52 , 54 , 55 , 59 – 75 , 81 , 82 , 84 – 86 , 89 , 91 – 95 , 98 – 100 fulfilled the inclusion criteria (Table 1 ). There were 146 (52%) female patients and 133 (48%) male, with a mean age at diagnosis of cryoglobulinemia of 54 years (range, 25–87 yr) and a mean age at life-threatening involvement of 55 years (range, 25–87 yr).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 205 patients with biopsy-proven cryoglobulinemic glomerulonephritis 3 – 8 , 12 , 16 , 18 , 19 , 24 , 25 , 36 , 39 , 42 – 47 , 50 – 52 , 54 , 55 , 60 – 67 , 69 – 71 , 74 , 75 , 77 , 81 , 82 , 84 – 86 , 91 – 95 , 98 , 99 (Table 2 ), 106 were male and 99 were female, with a mean age of 50 years at diagnosis of cryoglobulinemic vasculitis and 52 years at diagnosis of glomerulonephritis. The clinical presentation was nephrotic syndrome in 96 (47%) patients and nephritic syndrome (proteinuria, hypertension, general edema) in 19 (9%), while the remaining 90 (44%) patients had an indolent presentation with asymptomatic raised creatinine levels.…”

Section: Resultsmentioning

confidence: 99%

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Life-Threatening Cryoglobulinemic Patients With Hepatitis C

et al. 2013

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Cryoglobulinemia is characterized by a wide range of causes, symptoms, and outcomes. Hepatitis C virus (HCV) infection is detected in 30%–100% of patients with cryoglobulins. Although more than half the patients with cryoglobulinemic vasculitis present a relatively benign clinical course, some may present with potentially life-threatening situations. We conducted the current study to analyze the clinical characteristics and outcomes of HCV patients presenting with life-threatening cryoglobulinemic vasculitis. We evaluated 181 admissions from 89 HCV patients diagnosed with cryoglobulinemic vasculitis consecutively admitted to our department between 1995 and 2010. In addition, we performed a systematic analysis of cases reported to date through a MEDLINE search.The following organ involvements were considered to be potentially life-threatening in HCV patients with cryoglobulinemic vasculitis: cryoglobulinemic, biopsy-proven glomerulonephritis presenting with renal failure; gastrointestinal vasculitis; pulmonary hemorrhage; central nervous system (CNS) involvement; and myocardial involvement. A total of 279 patients (30 from our department and 249 from the literature search) fulfilled the inclusion criteria: 205 presented with renal failure, 45 with gastrointestinal vasculitis, 38 with CNS involvement, 18 with pulmonary hemorrhage, and 3 with myocardial involvement; 30 patients presented with more than 1 life-threatening cryoglobulinemic manifestation. There were 146 (52%) women and 133 (48%) men, with a mean age at diagnosis of cryoglobulinemia of 54 years (range, 25–87 yr) and a mean age at life-threatening involvement of 55 years (range, 25–87 yr). In 232 (83%) patients, life-threatening involvement was the first clinical manifestation of cryoglobulinemia. Severe involvement appeared a mean of 1.2 years (range, 1–11 yr) after the diagnosis of cryoglobulinemic vasculitis. Patients were followed for a mean of 14 months (range, 3–120 mo) after the diagnosis of life-threatening cryoglobulinemia. Sixty-three patients (22%) died. The main cause of death was sepsis (42%) in patients with glomerulonephritis, and cryoglobulinemic vasculitis itself in patients with gastrointestinal, pulmonary, and CNS involvement (60%, 57%, and 62%, respectively). In conclusion, HCV-related cryoglobulinemia may result in progressive (renal involvement) or acute (pulmonary hemorrhage, gastrointestinal ischemia, CNS involvement) life-threatening organ damage. The mortality rate of these manifestations ranges between 20% and 80%. Unfortunately, this may be the first cryoglobulinemic involvement in almost two-thirds of cases, highlighting the complex management and very elevated mortality of these cases.

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