OVERVIEW
Overview.
Cryoglobulinemia renal damage refers to the presence of increased cryoglobulins in the blood and manifestations of kidney damage such as proteinuria, hematuria, hypertension, and renal failure. The presence of hypocomplementemia in the blood may be accompanied by extrarenal manifestations such as fever, purpura, arthralgia, and Raynaud’s phenomenon.
Whether medical insurance
Yes
Department
Rheumatology, Nephrology
Clinical symptoms
Skin purpura, necrosis, ulceration, arthralgia, hematuria, hypertension, proteinuria, etc.
Hazards
The disease may recur and worsen, leading to cardiac and other organ involvement, and death in severe cases.
Complications
Hypertension, nephrotic syndrome, acute renal failure, etc.
Tests
Blood routine, urine routine, liver function test, kidney function test, C-reactive protein, blood cryoglobulin test, immunoglobulin, kidney biopsy, etc.
Diagnosis
There are typical features of renal damage, combined with positive blood cryoglobulin test can be initially diagnosed.
Treatment principle
Eliminate the cause of the disease, inhibit cryoglobulin, and protect renal function.
Curability
Difficult to cure.
Dietary advice
Give high-calorie, vitamin-rich, easy-to-digest diet.
Etiology
Causes
Cryoglobulinemia is often caused by tumors, infections and connective tissue diseases.
Symptoms and Diagnosis
Typical symptoms
Skin purpura and cold urticaria are the most common, and Raynaud’s phenomenon may occur in some patients. Patients may have arthralgia, hepatosplenomegaly, enlarged lymph nodes, peripheral neuritis (e.g., sensory abnormalities and numbness) and vasculitis syndrome. About 50% of patients have renal damage, and most patients have a slow, insidious onset of renal involvement. Patients present with nephritic syndrome manifested by hematuria, hypertension, proteinuria, and acute kidney injury; oliguric acute progressive nephritis is rare.
Diagnostic basis
History of cryoglobulinemia and symptoms of renal damage such as hematuria, hypertension, proteinuria, etc. 2. Positive blood cryoglobulin test. 3. Skin purpura biopsy may reveal cryoglobulin deposition. 4. Renal histopathology, light microscopy, is characterized by glomerular proliferative lesions such as mesangial endothelial hyperplasia and membranous glomerulonephritis, a few focal hyperplasia nephritis, and occasional membranous nephropathy. Electron microscopy is mainly characterized by amorphous electron-dense or crystal-forming material deposited under the endothelium or in the capillary lumen.
Treatment
Treatment guidelines
Eliminate the causes and triggers, inhibit or remove the cold globulin, strengthen the supportive symptomatic treatment.
Drug treatment
1. Glucocorticoids and immunosuppressants are commonly used in the treatment of patients with cryoglobulinemia combined with slow progression of renal damage, which can reduce proteinuria, but may not be of much value in improving renal function. In patients with severe cryoglobulinemic renal damage with acute progressive nephritic syndrome, cutaneous, neurologic, or visceral vasculitis episodic lesions, methylprednisolone combined with plasma exchange therapy, followed by short-term maintenance therapy with oral prednisone and cytotoxic medications is recommended.2. Antiviral agents are recommended for treatment of renal damage of cryoglobulinemia in patients with comorbid chronic hepatitis C viral infection The use of interferon can be applied alone, or interferon can be combined with ribavirin, polyethylene glycol interferon 2a or polyethylene glycol interferon 2b with ribavirin. In patients with markedly abnormal renal function, only regular interferon should be used.
Other treatments
Plasma exchange (3 times a week for 2-3 weeks), with the addition of plasma exchange with a pre-cooling device, is more effective and may result in a reduction in clinical manifestations and a decrease in blood creatinine in patients with renal impairment from cryoglobulinemia, but has no significant efficacy in neuropathy.
Prognosis.
Some patients may have spontaneous partial or complete remission of clinical manifestations, while most patients with renal damage may have recurrent or worsening nephropathy and systemic manifestations, or even end-stage renal failure. The main causes of death in patients with cryoglobulinemia are cardiovascular disease, other multiple organ involvement, or infection.
Nursing care
Daily care
1. Keep the environment clean, pay attention to personal hygiene, prevent respiratory infections, intestinal infections, urinary tract infections. 2. Combine work and rest, pay attention to rest and keep warm. Avoid strenuous activities, strengthen nutrition, and improve resistance.3. Appropriate exercise, choose suitable ways of exercise, such as walking, playing tai chi, etc., and avoid going to densely populated places.4. Follow the doctor’s instructions to take medication on time, do not arbitrarily increase or decrease the amount of medication, and avoid the use of medication that is harmful to renal function.5. Regular outpatient follow-up, and seek medical advice in case of changes in conditions.
Dietary management
Give high-calorie, vitamin-rich, easy-to-digest diet, and reduce the intake of high-protein food.