Meltzer Syndrome

Cryoglobulinemia leading to hematuria, anasarca, and progressive deterioration of the renal function. As the patient ages, hypertension, proteinuria, and elevated serum creatinine are present. Special attention to hypothermia and the possibility of hepatitis C.

Mixed Familial Cryoglobulinemia.

Autosomal dominant.

Cryoglobulinemia with systemic manifestations has acquired the name Meltzer syndrome. Cryoglobulins are immunoglobulins that persist in the serum, precipitate at cold temperature, and resolubilize when rewarmed. Type I is often associated with hematologic disorders. Types II and III are mixed, composed of different immunoglobulins with a monoclonal component in type II and only polyclonal immunoglobulins in type III. Hepatitis C virus is involved in most previously called essential mixed cryoglobulinemia. Dermatologic, rheumatologic, and nephrologic manifestations are the most frequent; neurologic complications are found in 20% of cases. End-stage cases may lead to renal insufficiency, hypertension, and anasarca.

Assessment of renal function is mandatory; check for hepatitis C. Keep all the perfused fluids (blood and electrolytes solutions) warm and pay attention to normothermia. In procedures that require hypothermia, plasma exchanges may help.