A 60 year old woman presents with generalized edema, skin ulceration and hypeension. Urine examination shows subnephrotic proteinuria (<2gm) and microscopic haematuria. Serum complement levels are decreased and she is positive for anti-hepatitis C antibodies. The likely diagnosis is:
Generalized edema, hypeension, sub-nephrotic proteinuria, hematuria, hypocomplimentemia and positive anti-hepatitis C antibodies are associated with Membranoproliferative Glomerulonephritis and Mixed Cryoglobulinemia. Mixed Cryoglobulinemia is more common in females and presents with stress ulceration, ahralgia, fatigue and Raynaud's phenomenon. The Presence of skin ulceration in a 60 yr old female suggests the diagnosis of Essential mixed cryoglobulinemia. Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 1682; Approach to Internal Medicine: A Resource Book for Clinical Practice, David Hui, 3rd Edition, Page 421.
PSGN
Essential mixed cryoglobulinemia
Membrano proliferative glomerulonephritis
Focal segmental glomerulosclerosis