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HBV Cryoglobulinaemic GN — ESENeph MCQ

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HardGlomerulonephritisHBV Cryoglobulinaemic GNESENeph

A patient with hepatitis-B viraemia has cryoglobulinaemic glomerulonephritis, nephrotic syndrome, progressive neuropathy and rapidly falling eGFR. What is the best treatment principle?

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Correct answer: DHBV antiviral treatment plus therapy for severe vasculitis

The viral driver must be treated with potent HBV antiviral therapy. Severe organ-threatening cryoglobulinaemic vasculitis may additionally require carefully coordinated immunosuppression, often rituximab-based, and occasionally plasma exchange. Antiviral treatment alone may be insufficient when neuropathy and rapidly progressive renal disease are already present, whereas immunosuppression without antiviral cover risks HBV flare. 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 Glomerular Diseases Guideline. https://kdigo.org/guidelines/gd/