Macroglobulinemia and membranoproliferative glomerulonephritis in a hepatitis C virus-positive patient

Area of Science:

• Nephrology
• Hepatology
• Hematology

Background:

• Hepatitis C virus (HCV) infection is a known cause of glomerulonephritis.
• Macroglobulinemia is a rare B-cell lymphoproliferative disorder.
• Membranoproliferative glomerulonephritis (MPGN) is a common renal manifestation of HCV and cryoglobulinemia.

Observation:

• A 72-year-old female with a history of HCV infection and macroglobulinemia presented with massive proteinuria.
• Renal biopsy revealed MPGN, and serum tests confirmed type 2 cryoglobulinemia.
• This represents the first reported instance of MPGN in an HCV-infected patient with co-existing macroglobulinemia.

Findings:

• Treatment with prednisolone and melphalan led to complete resolution of proteinuria.
• However, the macroglobulinemia and cryoglobulinemia remained unresponsive to the treatment regimen.

Implications:

• This case highlights the complex interplay between HCV, cryoglobulinemia, macroglobulinemia, and MPGN.
• Further research is needed to understand the pathogenesis and develop targeted therapies for this rare clinical presentation.
• The findings underscore the importance of comprehensive evaluation in patients with co-existing hematologic and renal disorders.