This is a 60-year-old male with a history of hypertension and chronic hypertensive renal failure and chronic liver disease HCV, without episodes of mental retardation or previous antiviral treatment.
The patient was admitted due to a primary immunodeficiency associated with exacerbation of chronic renal failure.
In the analytical study performed on admission, urea 169 mg/dl, creatinine 2.8 mg/dl, total bilirubin 0.6 mg/dl, AST 45 IU/L, HCV 33 IU/293 total albumin 27 mmol/L, bilirubin 5 000 gGT 85 U/ml
HCV genotype: 1B.
Urine: urinary excretion of Na 13 mEq/l.
Creatinine clearance 21.49 ml/min. No proteinuria.
Emergency paracentesis was performed due to mechanical compromise.
The patient developed a significant secondary subcutaneous haematoma and progressive deterioration of renal function.
The absence of proteinuria is attributed to a multifactorial origin by anemia secondary to hematoma and paracentesis.
Blood transfusion and volume expansion were performed, with no improvement.
After 15 days, persistent fever, generalized arthromyalgia, palpable purpura in the lower limbs and paresthesias were added to the clinical picture.
Analytically, deterioration of renal function persists, reaching plasma creatinine levels of 6.5 mg/dl and decreased creatinine clearance (10.10 ml/ml), objectifying also g/min with progressive proteinuria (0.15 g/min).
The appearance for the first time of cryoglobulinemia, the decrease of complement figures and the presence of leukocytoclastic vasculitis, suggested the existence of a MC associated with HCV and glomerulonephritis secondary to liver proliferative.
Treatment was initiated with intravenous doses of 1 mg/kg/day, with plasmapheresis being discouraged as well as other treatments given the patient's general and nutritional status and renal function parameters.
Despite treatment, the deterioration of renal function was progressive.
The patient entered the regular hemodialysis program three months after hospital admission, a situation in which he is still waiting for assessment of inclusion in the waiting list for double liver and kidney transplantation.
