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.
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.
Maisonobe T, Leger JM, Musset L, et al: Neurological manifestations in
cryoglobulinemia. Rev Neurol (Paris)