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November 9, 2017

Cryoglobulinemic Intimal Arteritis

This photomicrograph shows an artery with intimal edema and inflammation in a renal biopsy from a 56-year-old male with renal failure and nephrotic-range proteinuria. The patient’s serologic workup revealed evidence of an HCV infection and a positive rheumatoid factor. While the intima is inflamed and edematous, the media is relatively intact without inflammation or necrosis. Intimal arteritis is a pattern of vascular inflammation most commonly encountered in the transplant setting where it represents a rejection process. In the native kidney, this finding is most commonly seen in cryoglobulinemic vasculitis (which was the case for this patient). The differential diagnosis would include other forms of vasculitis such as ANCA-associated disease.