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  Monday, 13 February 2012
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2 patients of mine with positive HCV, Low C3, Low C4, and Negative Cryoglobulins: 1. 55 WF with CKD, eGFR 45, Creatinine baseline 1.2-1.3, HTN, Uncontrolled DM, HCV, Cirrhosis, Chronic liver disease,S/P Ribavirin complicated by Hemolytic Anemia 2 years ago. UA showed + Protein, No RBCs/WBCs, Negative Serum Cryoglobulins, Normal Renal US. Complement ordered as WORKUP for High Creatinine in HCV positive Patient although Urine protein is o.5 grams/day and negative Urine Blood/RBCs: she had Low C3 (63 mg/dL), Low C4 (7 mg/dL), Positive RF, Albumin 3.5. Cryoglobulins were sent anyways, came back NEGATIVE. How to pursue the abnormal complements further, is it from decreased Hepatic Synthetic Function? Is it from a Subtle GN? Should I consider a kidney biopsy? Do I send the Cryoglobulins level again? 2. Does severe sepsis cause Low complement as I see that in ICU sick Patients?
12 years ago

I believe that a subtle GN is possible in both cases and may due to MPGN which can occur in HCV infection, even in the absence of cryoglobulin. The other possibility is that the handling of the cryoglobulin was not correct by the lab or technician since the tubes need to be warmed and in fact the patient does have cryoglobulin.

In any event, if the consequence of the GN is low (low-grade proteinuria and in tact renal function), proof that this is GN may not be imperative since you likely would not treat with immunotherapy since there would be little to gain. If the GN was accelerating, then it might be important to know the histology (and whether cryoglobulins were present on EM) in order to guide therapy.
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