Cryoglobulinemic vasculitis and glomerulonephritis: concerns in clinical practice

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Cryoglobulinemia frequently leads to systemic vasculitis, impacting skin, internal organs like kidneys, and can be life-threatening.
• Understanding, detection, and treatment of cryoglobulinemia have seen recent advancements, crucial for clinical practice.

Purpose of the Study:

• To review recent progress in the understanding, detection, and treatment of cryoglobulinemia.
• To highlight clinical implications and advancements in managing cryoglobulinemic vasculitis (Cryo Vas) and cryoglobulinemic glomerulonephritis (Cryo GN).

Main Methods:

• Literature review of English and Chinese articles from PubMed and CNKI databases up to March 2019.
• Selection of key original articles, reviews, and treatment guidelines related to cryoglobulinemia and its underlying diseases.

Main Results:

• Accurate cryoglobulin detection requires maintaining blood sample temperature above 37°C.
• Cryo Vas, including Cryo GN, is common in types II and III mixed cryoglobulinemia, with skin purpura and low C4/C3 levels as indicators.
• Renal biopsy is key for Cryo GN diagnosis, often showing membranous proliferative GN; recent treatment advances for Cryo Vas are noted.

Conclusions:

• Standardization of laboratory serum cryoglobulin testing is urgently needed.
• Dissemination of recent diagnostic and treatment advancements for Cryo Vas and GN to clinicians is essential.