skip to main content

HCV Cryo GN Clinical Diagnosis — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGlomerulonephritisHCV Cryo GN Clinical DiagnosisESENeph

A 35-year-old man with haemophilia A and hepatitis C develops membranoproliferative glomerulonephritis. His cryoglobulins are positive and HCV RNA is detectable. He cannot undergo kidney biopsy due to bleeding risk. What imaging/laboratory combination best supports the clinical diagnosis without biopsy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Low C4 with normal C3 + cryoglobulins + HCV RNA + proteinuria/haematuria = clinical diagnosis of HCV-associated cryoglobulinaemic GN

In patients where kidney biopsy is contraindicated (bleeding risk from haemophilia), a clinical diagnosis can be made based on the characteristic biochemical pattern: low C4 with normal C3 (classical pathway activation by cryoglobulins), positive cryoglobulins, detectable HCV RNA, and clinical features (proteinuria, haematuria, reduced GFR, purpura). KDIGO 2021 acknowledges that biopsy confirmation may not always be feasible. Treatment with DAA therapy for HCV is the primary approach.

Reference: KDIGO 2021 – GN Guideline (Infection-Related GN)