title: Autoimmune hemolytic anemia occurred prior to evident nephropathy in a patient with chronic hepatitis C virus infection: case report.
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.
  
  
  METHODS
  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.
authors.affiliation: Internal medicine II, Nihon University School of Medicine, Tokyo, Japan. iohsawa@med.nihon-u.ac.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Ohsawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Uehara
authors.forename: Sumiko
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Morito
authors.initials: M
authors.lastname: Endo
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fujita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohi
mesh_terms: D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000150:complications* / Q000276:immunology; D001706:Biopsy; D006461:Hemolysis; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000276:immunology; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male