{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T12:42:40Z","timestamp":1782996160964,"version":"3.54.5"},"reference-count":100,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cryoglobulinemia is a rare disorder characterized by the presence of abnormal proteins (cryoglobulins) in the blood that precipitate at low temperatures. It presents with a wide clinical spectrum, from mild symptoms to severe, life-threatening disease. In mixed cryoglobulinemia (MC), vascular damage results from immune complexes\u2014typically monoclonal IgM with rheumatoid factor activity and polyclonal IgG (Type II), or polyclonal\/oligoclonal IgM and IgG (Type III). These complexes can obstruct small blood vessels, leading to ischemia and leukocytoclastic vasculitis. Renal involvement occurs in about 30% of MC patients and it is a manifestation with poor prognosis. Nowadays, types II and III MC are the most common forms, often linked to autoimmune diseases like Sj\u00f6gren\u2019s syndrome and systemic lupus erythematosus, or to viral infections such as hepatitis B or persisting despite hepatitis C eradication. This review explores renal involvement in MC, offering a comprehensive perspective on current knowledge, including recent advances in pathophysiological understanding, evolving diagnostic strategies, and novel therapeutic approaches. In this context, \u201cperspectives\u201d refers to the growing recognition of the shifting epidemiology of MC\u2014particularly the changing etiological landscape following hepatitis C virus eradication\u2014as well as the integration of emerging clinical and pathological entities such as cryofibrinogenemia and monoclonal gammopathy of renal significance into diagnostic and management frameworks. Furthermore, the review highlights current therapeutic strategies recognized as most effective, emphasizing the importance of a multidisciplinary and multimodal approach that combines etiological treatment, B-cell\u2013targeted therapy (notably rituximab), plasma exchange in selected cases, and comprehensive supportive care for renal and systemic complications. Moreover, the landscape of management could be enriched in future years, since clinical trials are ongoing to explore novel therapies for refractory or relapsing cases of MC with renal involvement.<\/jats:p>","DOI":"10.3390\/jcm14124369","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T06:11:07Z","timestamp":1750313467000},"page":"4369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Renal Involvement in Mixed Cryoglobulinemic Vasculitis: Current Perspectives"],"prefix":"10.3390","volume":"14","author":[{"given":"Annalisa","family":"Villa","sequence":"first","affiliation":[{"name":"Department of Transitional and Precision Medicine, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"},{"name":"Department of Molecular Medicine, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2015-765X","authenticated-orcid":false,"given":"Antonietta","family":"Gigante","sequence":"additional","affiliation":[{"name":"Department of Transitional and Precision Medicine, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1077-4846","authenticated-orcid":false,"given":"Chiara","family":"Pellicano","sequence":"additional","affiliation":[{"name":"Department of Transitional and Precision Medicine, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klara","family":"Radovic","sequence":"additional","affiliation":[{"name":"Department of Transitional and Precision Medicine, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Giannakakis","sequence":"additional","affiliation":[{"name":"Department of Radiological, Oncological and Anatomo-Pathological Sciences, Pathological Anatomy, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milvia","family":"Casato","sequence":"additional","affiliation":[{"name":"Department of Transitional and Precision Medicine, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Visentini","sequence":"additional","affiliation":[{"name":"Department of Transitional and Precision Medicine, Sapienza University of Rome, Viale dell\u2019Universit\u00e0 37, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.amjmed.2015.02.017","article-title":"Cryoglobulinemia Vasculitis","volume":"128","author":"Cacoub","year":"2015","journal-title":"Am. 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