Vasculitis with renal involvement in essential mixed cryoglobulinemia: Case report and mini-review

Table 1 Laboratory results from a patient with essential mixed cryoglobulinemic syndrome

Laboratory investigation	Test results (reference ranges)
Complete blood cell counts
Hemoglobin	8.5 g/dL (11.5-15.4 g/dL)
White blood cell count	15200 × 109/L (4.0-11.0 × 109/L)
Neutrophils	87% (40%-80%)
Lymphocytes	10% (20%-40%)
Platelets	23000/L (150-400 × 109/L)
Coagulation profile
APTT	28 s (25.8 s)
INR	1.98 (< 1.35)
Renal functions
Urea	88 mg/dL (15-39 mg/dL)
Creatinine	6.2 mg/dL (0.5-1.5 mg/dL)
Liver functions
Total bilirubin	6.1 mg/dL (0.2-1.0 mg/dL)
Direct bilirubin	3.2 mg/dL (0-0.25 mg/dL)
Alkaline phosphatase	202 U/mL (32-92 U/mL)
Alanine amino transferase	10 U/mL (10-40 U/mL)
Gamma glutamyl transferase	204 U/mL (7-64 U/mL)
Bone chemistry
Calcium	7.5 mg/dL (8.4-10.2 mg/dL)
Phosphorus	4.4 mg/dL (2.5-4.0 mg/dL)
Albumin	2.2 mg/dL (3.5-5.0 mg/dL)
Urine detailed report	Anuric on admission, later showed +2 proteinuria; no red blood cells, no cast
Immunological work-up
Complement 3	0.4 g/L (0.79-1.52 g/L)
Complement 4	0.01 g/L (0.16-0.38 g/L)
Anti-nuclear antibodies	Negative
ANCA	Negative
Rheumatoid factor activity	Positive: 859 IU/mL (cut off < 20 IU/mL)
Anti-cyclic citrullinated peptide	Negative
Anti-extractable nuclear antigens	Weakly positive for anti-Ro52
C-reactive protein	0.1 mg/dL (cut-off < 0.7 mg/dL)
Viral markers
HBsAg	Negative
Anti-HCV	Negative
Anti-HIV	Negative
HCV RNA	Not detected

ANCA: Anti-neutrophil cytoplasmic antibodies; APTT: Activated partial thromboplastin time; HBsAg: Hepatitis B surface antigens; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; INR: International normalized ratio.