PMC3482070_01
Renal biopsy findings in a patient with a cryoglobulin-induced immune complex glomerulonephritis. A Overview showing endocapillary glomerulonephritis with impressive hypercellularity. B Section of a glomerulus with mononuclear cells and polymorphonuclear neutrophils (indicated by arrows) in the glomerular convolutes. Immune complex-mediated glomerulonephritis positive for IgM (C) and complement C3 (D) by immunofluorescence staining.
cru-0002-0038-g01.jpg
PMC3482070_01_cru-0002-0038-g01.jpg
F1
C3 and C5b-9, resembling acute poststreptococcal glomerulonephritis; however, classical humps were missing (fig. 1). Comprehensive blood examinations revealed cryoglobulins (0.6 g/l), a monoclonal IgM (2 g/l), hypogammaglobulinemia (<5 g/l), and low complement C3 and C4 levels.
Clinical course before (A) and after initiation (B) of eculizumab in a patient with a cryoglobulin-induced glomerulonephritis. Serum creatinine levels and proteinuria in the years before and after initiation of eculizumab treatment are shown. Plasmapheresis is also indicated. Prot/Crea = Urine protein/creatinine ratio.
cru-0002-0038-g02.jpg
PMC3482070_01_cru-0002-0038-g02.jpg
F2
Fig. 2 shows the clinical course and renal function (i.e. serum creatinine and proteinuria), before and after initiating eculizumab. Plasmapheresis was restarted and renal function returned almost to baseline level (fig. 2).