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?