Recurrent essential mixed cryoglobulinemia in renal allografts. Report of two cases and review of the literature

This report describes two patients in whom essential IgG-IgM mixed cryoglobulinemia (EMC) glomerulonephritis led to end-stage renal disease. Both patients underwent primary hemodialysis, and during the period of uremia clinical and biological manifestations of the disease fully resolved. Transplantation was performed, and in both cases cryoglobulinemia quickly recurred (30 days and 6 months after transplantation, respectively) with clinical renal and extrarenal flare, and reappearance of the biological markers of the disease (decrease in C3 and C4 components of serum complement, detection of rheumatoid activity and of cryoglobulinemia in the serum). The literature on EMC glomerulonephritis leading to end-stage renal disease is reviewed. Factors that may have contributed to extinguishing the disease and to further recurrence following transplantation-consequences of uremic state, alloimmunization and intercurrent infectious disease-are discussed.