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Hepatitis C cryoglobulinaemic GN — ESENeph MCQ

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HardGlomerulonephritisHepatitis C cryoglobulinaemic GNESENeph

A 58-year-old man with chronic hepatitis C presents with purpura, arthralgia and ankle oedema. Creatinine is 156 micromol/L, urine PCR is 360 mg/mmol and C4 is very low. Rheumatoid factor is positive and serum cryoglobulins are detected. Renal biopsy shows membranoproliferative glomerulonephritis. What is the most likely underlying cause?

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Correct answer: B — Hepatitis C-associated mixed cryoglobulinaemia

Hepatitis C with palpable purpura, low C4, rheumatoid factor positivity and cryoglobulins is classic for mixed cryoglobulinaemia causing MPGN. IgA nephropathy does not typically produce marked C4 depression or cryoglobulinaemia. Anti-GBM disease causes rapidly progressive glomerulonephritis with linear IgG rather than immune-complex MPGN. The pearl is that antiviral therapy and immunosuppression decisions should be coordinated with hepatology and nephrology.

Reference: KDIGO 2022 Hepatitis C in CKD Guideline; KDIGO 2021 Glomerular Diseases Guideline