Cryoglobulinaemic GN — ESENeph MCQ

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HardGlomerulonephritisCryoglobulinaemic GNESENeph

A 47-year-old woman presents with malaise, arthralgia, purpura on her lower limbs, and an eGFR of 45 mL/min/1.73m2 with uACR 120 mg/mmol and active sediment. She is hepatitis C antibody positive with detectable HCV RNA. Cryoglobulins are positive. Complement C4 is low. What is the most appropriate first-line treatment?

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Correct answer: B — Direct-acting antiviral treatment for HCV

This presentation is consistent with HCV-associated cryoglobulinaemic glomerulonephritis (Type II mixed cryoglobulinaemia). KDIGO 2021 GN guideline recommends that treatment should focus on eradicating the underlying infection with DAA therapy as first-line. Immunosuppression (Rituximab, plasma exchange) is reserved for severe or life-threatening disease (e.g. rapidly progressive GN, vasculitic flares). Low C4 with normal C3 is characteristic of cryoglobulinaemia. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO 2021 – Clinical Practice Guideline for Glomerular Diseases: https://kdigo.org/guidelines/gd/