Cirrhotic glomerulonephritis: an underdiagnosed condition

Glomerular pathology in liver cirrhosis is common in autopsies but is underdiagnosed antemortem. The most common pathologic findings are mesangial disease with immunoglobulin A deposits, and membranoproliferative glomerulonephritis. The latter is associated, most frequently, with hepatitis C infection and cryoglobulinemia. We describe a patient with longstanding liver cirrhosis who presented with a nephritic and nephrotic syndrome. Membranoproliferative glomerulonephritis was diagnosed on kidney biopsy. There was no clinical, laboratory or histologic evidence of hepatitis C infection or cryoglobulinemia. The different aspects of "cirrhotic glomerulonephritis" are discussed and the need for searching for this underdiagnosed condition in patients with chronic liver disease is emphasized.