الفهرس 
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Abstract
Cryoglobulinemia refers to a pathologic condition caused by production of circulating immunoglobulins that precipitate on cooling and resolubilize on warming. It is associated with a variety of infections especially HCV, HBV, HGV, SLE, polyarteritis nodosa, autoimmune thyroiditis, multiple myeloma and Walden-Strom macroglobulinemia, etc. (Sansonno et al., 2005).
Important advances have been obtained in understanding the epidemiology, etiology and the pathogenesis of cryoglobulinemia. The recognition of the major role played by HCV infection as a trigger and maintenance factor of the disease has allowed effective antiviral treatment for this condition. The demonstration of the underlying B- cell clonal expansion and the possible evolution into a B- cell lymphoma as a result of prolonged HCV stimulation represent a biological basis for innovative approaches with anti CD20 monoclonal antibodies. Several biological aspects however remain to be clarified.
This study was conducted on forty patients with chronic renal failure receiving regular hemodialysis sessions ( three sessions / week) randomly selected from the hemodialysis unit of AinShams university hospital regardless of their hepatitis C virus infection status( infected or not). The patients will be subdivided into 2 groups:-
Group A: - Includes 20 patients with +ve hepatitis C virus antibodies.
Group B: - Includes 20 patients with –ve hepatitis C virus antibodies.
All selected patients will be subjected to the following:-
[1] Full history taking with special concern to the etiology of chronic renal failure and the duration of dialysis.
[2]Complete physical examination especially for the presence of any stigmata of cryoglobulinemia.
[3] Routine blood chemistry including:- -Routine CBC. -Electrolytes (serum Na, serum K, serum Ca, serum iP and serum albumin). - Kidney function tests (serum urea & serum creatinine).
-Liver enzymes (ALT, AST). -Routine coagulation profile (PT, PTT and INR). - ESR and CRP ( quantitative). -HBsAg and HCVab.
[4] Test for cryoglobulin detection (duplicate samples).
[5] PCR for patients with –ve hepatitis C virus antibodies & +ve cryoglobulin.
[6] Necessary investigations according to the clinical condition .
Our study reveals that the frequency of cryoglobulinemia among hemodialysis patient in group A was 5% and in group B was 5%.
Cryoglobulinemia is rare among hemodialysis patients and play no role for causes of morbidity, mortality and hospitalization. One can speculate that, exposure to cryoglobulin could result in increased risk of vascular complications. Further studies are necessary to determine whether cryoglobulinemia are involved with the high incidence of vascular access thrombosis in this population.
Conclusion
We may conclude that, hemodialysis patients with or without hepatitis C virus infection is rarely associated with cryoglobulinemia. These antibodies do not lead to morbidity and mortality. There is no association between cryoglobulinemia and hepatitis C virus infection. Cryoglobulinemia is an epiphenomenon and does not lead to clinical manifestations. Further studies are necessary to determine the prevalence of cryoglobulinemia among hemodialysis patients and its specific treatment.