How do you approach management of a patient with Sjögren’s-associated cryoglobulinemic vasculitis who has worsening renal function, but kidney biopsy is not feasible?  

The patient initially had gastrointestinal symptoms/colitis, leukocytoclastic vasculitis rash, low complements, cryocrit 3%, myalgias, and new peripheral neuropathy.

The patient has a solitary kidney, so biopsy is being avoided.