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Kidney International, Vol. 47 (1995), pp. 618—623

Long-term predictors of survival in essential mixed cryoglobulinemic glomerulonephritis

Divisione di Nefrologia e Dialisi, Istituto diRicovero e Cura a Carattere Scientifico, Ospedale Maggiore di Milano; Divisione di Nefrologia, Ospedale Ca' Granda di Milano; Divisione di Nefrologia, Ospedale S. Carlo Borromeo di Milano; Direzione Scientifica, Ospedale Maggiore di Milano, Milan, Italy

Long-term predictors of survival in essential mixed cryoglobulinemic glomerulonephritis. We report the clinical outcome of 105 essential mixedrenal involvement, in the duration of follow-up and in the type of

ciyoglobulinemia (EMC) patients with renal involvement collected
throughout 25 years in three renal Units of Milan. The median follow-up was 72 months since renal biopsy and 131 months since the clinical onset of EMC. Patient survival was 49% at 10 years after renal biopsy. Forty-two patients died primarily fromcardiovascular and liver disease or infection, whereas 15 patients developed chronic renal failure. Two patients had a complete remission of the disease while 15 had a remission only of renal signs. Thirty-one patients are alive with persistent renal and extrarenal manifestations. Anti-HCV antibodies were retrospectively detected in 34 patients and were present in 85% of them. This variable was not includedin the statistical evaluation. At multivariate analysis, age older than 50 years, purpura, splenomegaly, cryocrit levels higher than 10%, C3 plasma levels lower than 54 mgldl, and serum creatinine higher than 1.5 mg/dl were independent risk factors for death or dialysis. In conclusion, several

treatment, as well as the small number of patients enrolled in different series, have not permitted adefinition of the long-term prognosis and the prognostic predictors of patients with EMC
nephritis. In this paper we report the long-term outcome of 105 patients

with EMC nephritis who were followed by three renal units
working in Milan. Methods

The medical histories of all patients with EMC who were
hospitalized at the Nephrology Divisions of Ospedale Maggiore, Ospedale S. Carlo andOspedale Ca' Granda of Milan, between 1966 and 1990 were reviewed. Patients were eligible for the study if they had a diagnosis of EMC nephritis made according to the following criteria: (a) circulating cryoglobulins, (b) rheumatoid factor activity in their serum, (c) history of recurrent episodes of purpura, (d) urinary protein excretion greater than 0.5 g per day and/or urinary sediment showingerythrocytes and casts, (e) renal

factors may influence the outcome of patients with EMC nephritis.
Markers of disease activity and an impaired renal function can herald a bad prognosis. It should be stressed, however, that only a minority of patients eventually develop renal failure, probably because in the most severe cases patients die earlier.

After the initial description by Meltzer andFranklin [1], several papers have reviewed the clinical features of the so-called essential mixed cryoglobulinemia (EMC) [2—4], a disease caused by the formation of high molecular weight aggregates of two immunoglobulins: usually a polyclonal IgG and a monoclonal 1gM with antiglobulin activity. The etiology of EMC is unknown. Recently it

biopsy showing a pattern of cryoglobulinemic nephritis, (f)a
minimum follow-up of one year after diagnosis unless the patient

died or progressed to renal failure. Out of 140 patients given a diagnosis of EMC, 35 were excluded because of a too short follow-up or lack of renal biopsy; 105 patients fulfilled the above inclusion criteria and were selected for this study. The ciyoglobulin typing showed: type I cryoglobulinemia in 4 patients, type II has...
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