skip to main content

Cryoglobulinaemic GN — RACP Adult Medicine MCQ

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

HardNephrologyCryoglobulinaemic GNRACP Adult Medicine

A 55-year-old man with chronic hepatitis C and cryoglobulinaemia presents with palpable purpura, arthralgia, and progressive renal impairment. Renal biopsy shows membranoproliferative glomerulonephritis with subendothelial deposits. Complement C4 is very low. What is the primary treatment approach?

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

Reveal the answer and explanation

Correct answer: E — Direct-acting antiviral therapy for HCV

HCV-associated cryoglobulinaemia with renal involvement should be treated primarily by eradicating HCV with direct-acting antiviral (DAA) therapy, which addresses the underlying cause of cryoglobulin production. SVR leads to disappearance of cryoglobulins in most patients. For severe organ-threatening disease (rapidly progressive GN, severe neuropathy), rituximab and/or plasma exchange may be added alongside DAA therapy. Low C4 with normal C3 is characteristic of cryoglobulinaemia (classical pathway activation).

Reference: eTG – 2025 – Gastrointestinal; KDIGO – 2021 – Hepatitis-Associated GN Guidelines