Clinico-biological characteristics and treatment of hepatitis B virus-related mixed cryoglobulinemia

• Published in: Chinese medical journal 2021-08, Vol.135 (3), p.371-373
• Main Authors: Wang, Xiufen, Xiao, Xiangcheng, Ge, Huipeng, Deng, Tianci, Zhou, Qiaoling, Ning, Jianping, Wu, Xiaoying, Yin, Hongling, Lin, Wei, Tang, Wenbin
• Format: Article
• Language: English
• Subjects: Antibodies; Antigens; Biopsy; Correspondence; Creatinine; Cryoglobulinemia; Disease; Drugs; Hepacivirus; Hepatitis B; Hepatitis B virus; Hepatitis C; Humans; Kidneys; Laboratories; Microscopy; Nervous system; Patients; Peripheral neuropathy; Purpura; Remission (Medicine); Serology; Standard deviation; Steroids; Ulcers; Urine; Viral infections; Viruses
• ISSN: 0366-6999; 2542-5641
• DOI: 10.1097/CM9.0000000000001714

Laboratory test results indicated the following values: albumin 34 g/L, creatinine 199.0 μmol/L, complement C3 35.60 mg/dL, complement C4 3.27 mg/dL, RF 128 IU/mL; also, 24-h urine protein was 0.56 g while urine volume was 200 mL. Electron microscopy found basement membrane reduplication and organized subendothelial microtubular substructure deposits, indicating HBV-related cryoglobulinemic glomerulonephritis likelihood [Supplementary Figure 1, http://links.lww.com/CM9/A731]. Demographic information, extrahepatic clinical manifestation, laboratory test data, treatment, and outcome were collected. Characteristics Values Socio-demographic features  Age (years) 53 ± 14  Sex/male 20 (47.6) Extrahepatic clinical manifestations   Cutaneous 33 (78.6)   Purpura 25 (59.5)   Necrosis 5 (11.9)   Ulcers 3 (7.1)   Peripheral neuropathy 15 (35.7)   Central nervous system involvement 1 (2.4)   Articular 8 (19.0)   Kidney 23 (54.8)   Gastrointestinal 3 (7.1)   Cardiac 1 (2.4)   Eyes 1 (2.4) Laboratory testing   Type of cryoglobulin    Type II 21/34 (61.8)    Type III 13/34 (38.2)   Albumin (g/L) 27 ± 5 (n = 21)   Alanine aminotransferase (U/L) 71 (30–107) (n = 29)   Creatinine∗ (μmmol/L) 244 (164–380) (n = 22)   Complement    Low C3 17/28 (60.7)    Low C4 27/31 (87.1)   Positive of RF 25/27 (92.6)   HBV DNA (U/mL) 5.0 × 104 (8.2 × 103–5.2 × 105) (n = 28)   Negative of HBV DNA 5/36 (13.9) Treatment†   Anti-HBV 36 (85.7)    Entecavir 17 (40.5)    Lamivudine 11 (26.2)    Telbivudine 7 (16.7)    Interferon 2 (4.8)    Adefovir 2 (4.8)    Tenofovir 2 (4.8)   CS 22 (52.4)   IS 13 (31.0)    CYC 7 (16.7)    MMF 5 (11.9)    RTX 4 (9.5)   PE 9 (21.4) Outcome  Remission 22 (52.4)  Refractory 20 (47.6)  Death 5 (11.9) Data are presented as n (%) or mean ± standard deviation or median (interquartile range). ∗Median creatinine of patients with kidney involvement. †The first stage of therapy and the second stage of therapy are calculated as a whole.