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Ultrasonographic Evaluation of Salivary Glands for Sjogren's Syndrome: Diagnostic and Monitoring Insights
Published on: October 13, 2023
Clinically Silent Sjögren Syndrome Presenting With Cryoglobulinemia
Ameya Deshpande1, Md Ali Osama2, Pallav Gupta3
1Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India.
International Journal of Surgical Pathology
|June 3, 2026
Summary
This case study shows how kidney biopsy can reveal hidden Sjögren syndrome (SS) in a patient with cryoglobulinemic glomerulonephritis. Early diagnosis of SS is crucial for managing renal complications.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Cryoglobulinemia is an immune complex disorder linked to autoimmune diseases, infections, and lymphoproliferative conditions.
- Renal involvement is a common manifestation of cryoglobulinemia and can indicate underlying systemic disease.
- Sjögren syndrome (SS) is an autoimmune disorder typically presenting with sicca symptoms, but can manifest primarily with renal involvement.
Purpose of the Study:
- To highlight the diagnostic utility of kidney biopsy in identifying cryoglobulinemic glomerulonephritis.
- To emphasize the potential for Sjögren syndrome to present initially with isolated renal manifestations.
- To underscore the importance of early recognition and immunomodulatory therapy for cryoglobulinemia and associated autoimmune diseases.
Main Methods:
- A case report of a 33-year-old woman with pedal edema, arthralgia, hematuria, and impaired renal function.
- Kidney biopsy analysis revealing intraluminal pseudothrombi with immunoglobulin M deposition (cryoglobulinemic glomerulonephritis).
- Serologic testing for cryoglobulinemia and autoantibodies (anti-SSA/Ro, anti-SSB/La), and labial salivary gland biopsy to diagnose Sjögren syndrome.
Main Results:
- The patient was diagnosed with mixed cryoglobulinemia and Sjögren syndrome based on kidney biopsy, serology, and salivary gland biopsy.
- Treatment with corticosteroids and rituximab improved renal function.
- A complication of secondary thrombotic microangiopathy responded to plasma exchange.
Conclusions:
- Kidney biopsy is invaluable for diagnosing cryoglobulinemic glomerulonephritis and uncovering occult systemic autoimmune diseases like Sjögren syndrome.
- Sjögren syndrome can present with renal-only symptoms, necessitating thorough autoimmune workup.
- Timely diagnosis and immunomodulatory treatment are essential for managing cryoglobulinemic glomerulonephritis and preventing further renal damage.
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