Which infection is most commonly linked to cryoglobulinemia presenting with glomerulonephritis?

• A. Hepatitis B
• B. Hepatitis C
• C. HIV
• D. Malaria

Answer: (B)

Chronic Hepatitis C infection is the most common infection linked to cryoglobulinemia presenting with glomerulonephritis. The cryoglobulins are immune complexes, often mixed (type II or III) with rheumatoid factor activity, that form in the setting of ongoing HCV-driven B-cell stimulation. These complexes deposit in small vessels, including the glomeruli, triggering an inflammatory response that commonly produces a membranoproliferative pattern of glomerulonephritis and consumes complement (especially C4). Clinically, this presents with features of GN such as proteinuria and hematuria, and may be part of a broader cryoglobulinemic syndrome (often with purpura and arthralgias).

Hepatitis B can be associated with cryoglobulinemia but far less commonly, while HIV and malaria are not typical culprits for this specific presentation. Treating the underlying Hepatitis C with antiviral therapy can reduce cryoglobulin production and improve renal outcomes; in severe cases, plasmapheresis or rituximab may be used.