ArticleFrontiers in immunology2025
Renal prognostic value of serum monoclonal immunoglobulin in cryoglobulinemic glomerulonephritis.
Article in Frontiers in immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: To explore the clinicopathological features and renal outcome in patients with cryoglobulinemic glomerulonephritis (Cryo-GN) without confirmed systemic autoimmune diseases. Methods: Sixty-nine patients with Cryo-GN from a single center were recruited in this retrospective study. Their clinical, pathologic, and follow-up data were collected and analyzed. According to whether the serum monoclonal immunoglobulin (MIg) and HBV-DNA/HBV markers or HCV-RNA/anti-HCV antibodies were positive or not, they were classified into four groups: positive serum MIg only (MIg group), positive HBV-DNA/HBV markers or HCV-RNA/anti-HCV antibodies (HBV/HCV) only (HBV/HCV group), positive serum MIg and HBV/HCV (MIg+HBV/HCV group), and all MIg/HBV/HCV negative group. Results: The male-to-female ratio was 1.38:1 with a mean age of 50.4 ± 14.7 years in the patient cohort. Hypertension was presented in 59.4% of cases, anemia in 73.9%, renal insufficiency in 60.9%, nephrotic proteinuria in 44.9% and microscopic hematuria in 94.2%. The MIg group had significantly lower eGFR levels, higher cryoglobulin levels, and higher rates of abnormal serum-free light chain ratios than the MIg/HBV/HCV negative group. The most common histological pattern of Cryo-GN was membranoproliferative glomerulonephritis (MPGN), and the MIg group had significantly higher scores of the severity of intracapillary cryo-Plugs than the MIg+HBV/HCV group and the MIg/HBV/HCV negative group. Immunohistochemical staining of 29 patients revealed a significant infiltration of CD68+ cells within the glomeruli. Further multiplex immunohistochemical staining of 4 of these patients showed that the infiltrating cells within the glomeruli in Cryo-GN were predominantly CD68+CD163+ cells. Sixty-seven patients had a median follow-up of 31.7 months, and 23.9% of them progressed to end-stage renal disease (ESRD). The renal survival was inferior for MIg group than HBV/HCV group. Multivariate analysis showed that serum MIg and eGFR were independent prognostic factors. Conclusion: Regardless of the presence of HBV/HCV infection, non-systemic autoimmune diseases related Cryo-GN patients with serum MIg had worse renal function and renal survival. Patients with a large number of pseudothrombi in the glomerular capillary lumens tend to have worse renal outcomes. Serum MIg and eGFR were independent risk factors for renal survival in Cryo-GN patients without autoimmune diseases.
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