Background: Renal involvement in patients with chronic hepatitis C virus infection has suggested to be due to a variety of immunological processes. However, the precise mechanism which the kidneys are damaged in these patients is still unclear. Case presentation: A 66 year old man presented with the sudden onset of autoimmune hemolytic anemia. Concomitant with a worsening of hemolysis, his initially mild proteinuria hemoglobinuria progressed. On admission, laboratory tests revealed that he was positive 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 positive of syphilic test. Renal biopsy specimens showed signs of immune complex nephropathy with hemosiderin deposition in the tubular epithelial cells. Conclusions: The renal histological findings in this case are consistent with the deposition 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 infection.
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