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Roccatello D, Sciascia S, Naretto C, Barreca A, Solfietti L, Battaglia L, Viziello L, Fenoglio R, Rossi D. Recognizing the new disorder "idiopathic hypocryoglobulinaemia" in patients with previously unidentified clinical conditions. Sci Rep 2022; 12:14904. [PMID: 36050335 PMCID: PMC9437023 DOI: 10.1038/s41598-022-18427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
A considerable number of patients with high clinical suspicion for cryoglobulinaemic vasculitis either show negative results for the detection of cryoglobulins or show only trace amounts which cannot be characterized for composition. We aimed at establishing whether the failure to detect or the detection of trace amounts of cryoglobulin with conventional methods either identifies a peculiar subset of low level cryoglobulinaemia (from now on hypocryoglobulinaemia) or represents a separate entity. Using a modified precipitation technique in hypo-ionic medium, we prospectively identified between 2008 and 2021 237 patients (median age 60.8 years [22-97], 137 females) having < 0.5% cryocrit and clinical suspicion of autoimmune disorder. Of these 237 patients, only 54 (22.7%) had a history of HCV infection. One hundred and sixty-nine out of 237 patients (71%) had an established underlying disease, while 68 patients (28.6%) (median age 62.9 years [29-93], 35 females) did not show either laboratory markers or clinical symptoms consonant with an underlying aetiology. These 68 cases with only trace amounts of cryoglobulins were defined as having a putatively idiopathic hypocryoglobulinaemia. Nineteen of these 68 patients (27.9%) had a history of HCV infection. Twenty-four patients out of 68 (35.3%) were positive for rheumatoid factor (RF), while 25 (36.7%) patients had signs of complement consumption (i.e., C4 < 15 mg/dl and/or C3 < 80 mg/dl ), and 36 (52.9%) had increased inflammatory indexes. Seven patients only had arthralgia and constitutional symptoms while 61 out of 68 (89.7%) presented with at least one of the three cardinal signs of cryoglobulinaemic vasculitis including skin lesions, peripheral nerve involvement, and glomerulonephritis. Seventy-five percent of the subjects had type III hypocryoglobulins. In patients with hypocryoglobulinaemia the histologic features of glomerulonephritis (also examined by electron microscopy) resembled those of mixed cryoglobulinaemia-associated glomerulonephritis. In conclusion, hypocryoglobulins are often polyclonal and are mainly unrelated to HCV infection. Patients who present high clinical suspicion for vasculitis, especially glomerulonephritis and yet test negative for cryoglobulinaemia detected by standard techniques, could require deeper investigation even in the absence of HCV infection, RF activity or signs of complement consumption.
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Affiliation(s)
- Dario Roccatello
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy.
| | - Savino Sciascia
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Carla Naretto
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Antonella Barreca
- Pathology Division, Città della Salute e Della Scienza, Torino, Italy
| | - Laura Solfietti
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Laura Battaglia
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Lucia Viziello
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Roberta Fenoglio
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Daniela Rossi
- CMID-Nephrology and Dialysis Unit (ERK-Net, ERN-ReConnet, RITA-ERN Member), Research Center of Immunopathology and Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, S. Giovanni Bosco Hub Hospital and Department of Clinical and Biological Sciences, University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
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