Hepatitis C with MPGN

Jumbled

Step 1: View clinicals

A 62 year old woman presents with fever, vomiting, and dysuria for 3 days. Further questioning reveals a history of dizziness and easy fatigability for the last 3 months, along with frothy urine. Her medical history is significant for Hepatitis C infection diagnosed 3 years ago. She defaulted on follow up thereafter. She does not smoke or consume alcohol, and denies drug abuse.


Step 2: Order all relevant investigations

Renal Functions + eGFR

BUN: 60 mg/dL (20-30) Serum creatine: 2.2 mg/dL (0.4-1.1) eGFR: 61 ml/min/1.73m2

Anti-HCV Abs & HCV RNA

The enzyme immunoassay for anti-HCV antibodies is reactive. The HCV RNA test is positive.

USS Abdomen & Pelvis

Both kidneys are mildly enlarged. The liver is of normal size and echogenicity. No other abnormalities are noted.

Urinalysis + Culture & ABST

Color: Yellow & Turbid Urinary Protein: ++ Urinary Glucose: none Pus Cells: 50-55/hpf Red Cells: occasional Epithelial Cells: occasional White cell casts: + Organisms: + Gram Stain: multiple gram negative rods Culture: results will be available in 3 days


Step 3: Select appropriate management

Anti-HCV Therapy
Corticosteroids
Antihypertensives
IV Ceftriaxone


Score: ★★☆