Renal involvement in hepatitis C infection: Cryoglobulinemic glomerulonephritis

Abstract

Patient 1. A 49-year-old man reported recurrent episodes of arthralgia, purpura, and abdominal colic over 2 years. He was transferred to the San Carlo Hospital in Milan from another hospital, where he had been admitted because of fever, abdominal pain, purpura and edema of the legs, slightly increased serum creatinine (1.5 mg/dl), nephrotic-range proteinuria (4–5 g/day), and positive serum cryoglobulins (cryocrit 1%). On admission to San Carlo Hospital, the proteinuria was still in the nephrotic range, with reduced total serum proteins (4.9 g/dl), and the cryocrit was 11%, with mixed cryoglobulins characterized as IgG-IgM. Serum C4 was almost undetectable, with C3 moderately reduced; ALT was 57 U/liter. Hepatomegaly was present, and a liver biopsy disclosed mild active chronic hepatitis. Markers for HBV were negative, while anti-HCV antibodies were detected a posteriori in the stored serum. His blood pressure was markedly elevated, and severe retinal lesions (grade 3 hypertensive retinopathy) were present.