Autoimmune hemolytic anemia occurred prior to evident nephropathy in a patient with chronic hepatitis C virus infection: case report

Isao Ohsawa¹ , Yuki Uehara² , Sumiko Hashimoto³ , Morito Endo¹ , Takayuki Fujita¹ and Hiroyuki Ohi¹

¹Internal medicine II Nihon University School of Medicine, Tokyo, Japan

²Department of laboratory medicine, Nihon University School of Medicine, Tokyo, Japan

³Clinical laboratory, Nihon University Itabashi hospital, Tokyo, Japan

author email corresponding author email

BMC Nephrology 2003, 4:7doi:10.1186/1471-2369-4-7


Published:	29 August 2003

Abstract

Background

Renal involvement in patients with chronic hepatitis C virus infection has been suggested to be due to a variety of immunological processes. However, the precise mechanism by which the kidneys are damaged in these patients is still unclear.

Case presentation

A 66 year old man presented with the sudden onset of autoimmune hemolytic anemia. Concomitant with a worsening of hemolysis, his initially mild proteinuria and hemoglobinuria progressed. On admission, laboratory tests revealed that he was positive for hepatitis C virus in his blood, though his liver function tests were all normal. The patient displayed cryoglobulinemia and hypocomplementemia with cold activation, and exhibited a biological false positive of syphilic test. Renal biopsy specimens showed signs of immune complex type nephropathy with hemosiderin deposition in the tubular epithelial cells.

Conclusions

The renal histological findings in this case are consistent with the deposition of immune complexes and hemolytic products, which might have occurred as a result of the patient's underlying autoimmune imbalance, autoimmune hemolytic anemia, and chronic hepatitis C virus infection.