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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span></p><p class="elsevierStylePara">We report the case of a 48-year-old woman&#44; smoker&#44; with a history of allergic rhinitis and bronchial hyperreactivity&#46; Surgery for tonsillectomy&#44; basal-cell carcinoma and cervical conization due to CIN II moderate dysplasia&#44; infection due to the human papilloma virus&#44; erosive cervicitis and squamous metaplasia&#46; Admitted in July 2008 due to painless haematuria persisting for months&#44; with no history of lithiasis or urinary infection&#46; Microhaematuria &#40;30-50 RBC&#47;F&#41; was confirmed with 8&#37;-15&#37; of dymorphias without microalbuminuria &#40;0&#46;15g proteinuria in 24-hour urine&#41;&#46;</p><p class="elsevierStylePara">The physical examination&#44; Ambulatory Blood Pressure Monitoring &#40;ABPM&#41;&#44; bladder-kidney echo-Doppler and renal angiography were normal&#46; Bladder lesions were ruled out by cystography and the urinary cytology was negative for neoplastic cells&#46;</p><p class="elsevierStylePara">Analysis&#58; persistently high levels of IgE&#44; IgM &#40;220-400mg&#47;dl&#41; and ASLO &#40;antistreptolysin antibodies&#41; &#40;330-338IU&#47;l&#41; were detected&#46; Rest of autoimmunity &#40;cryoglobulins&#44; rheumatoid factor&#44; IgA&#44; IgG&#44; C3&#44; C4&#44; antinuclear antibodies&#44; antineutrophil cytoplasmic antibodies&#44; anti-GBM antibodies&#44; protein electrophoresis&#41; and tumour markers were normal&#46; Viral serology&#44; however&#44; showed clear negativity for hepatitis A and B &#40;HBsAg neg&#44; HBsAb &#43;&#44; HBcAc neg&#41; and the human immunodeficiency virus&#44; but not for hepatitis C virus &#40;HCV&#41;&#44; which was repeatedly inconclusive or indeterminate &#40;immunoblotting band C1 positive&#59; C2&#44; E2&#44; NS3 and NS4 negative&#41; with negative polymerase chain reaction for classic HCV&#46; Blood count&#44; lipid profile&#44; glucose&#44; urea&#44; creatinine&#44; uric acid&#44; ions&#44; glutamic pyruvic transaminase &#40;GPT&#41; and gamma-glutamyl transferase &#40;GGT&#41; were normal&#46; Glutamic oxaloacetic transaminase &#40;GOT&#41; and total minimum bilirubin were temporarily high &#40;32-41IU&#47;ml and 1&#46;42mg&#47;dl&#44; respectively&#41;&#44; and subsequently remained within the normal range &#40;&#60;22IU&#47;ml and &#60;1&#46;00mg&#47;dl&#41;&#46;</p><p class="elsevierStylePara">Percutaneous renal biopsy was performed&#44; with the following findings &#40;Figure 1 and Figure 2&#41;&#58; &#34;Optical microscopy&#58; nine glomeruli without sclerosis&#44; hypertrophy or significant increase in cellularity&#44; apart from slight mesangial proliferation of focal segmental distribution&#59; slight diffuse increase in mesangial matrix and in some granulocyte in the flocculonodular lobe&#59; absence of interstitial inflammatory infiltrate and pathology in the basement membrane &#40;BM&#41;&#59; mild focal periglomerular fibrosis&#46; Immunofluorescence&#58; negative for IgG&#44; IgA&#44; C1q&#44; kappa and lambda chains&#46; Glomerular IgM &#40;&#43;&#47;-&#41; with positive C3 in some Bowman&#39;s capsules&#46; Electron microscopy&#58; a glomerulus with an increase in mesangial matrix with BM of normal thickness and absence of electron dense deposits&#34;&#46; The diagnosis from the pathological point of view was&#58; &#34;Minimal glomerular lesions&#44; mainly mesangial&#46;&#34;</p><p class="elsevierStylePara">Bearing in mind the high level of ASLO&#44; the focal and segmental character of mesangial lesions and their coexistence with isolated neutrophilic granulocytes&#44; we considered the possibility of a previous subclinical postinfectious glomerulonephritis&#46;</p><p class="elsevierStylePara">In 2010&#44; the patient still had haematuria and the previous analytical abnormalities&#44; without displaying outbreaks of allergies during her progression&#46; We insisted on diagnosing HCV&#44; with samples being sent for detection by high resolution techniques &#40;RNA in peripheral blood mononuclear cells and RNA by ultracentrifugation in serum<span class="elsevierStyleSup">1&#44;2</span>&#41;&#44; being negative for the first but positive for the second &#40;240 copies&#47;ml&#41;&#46; The FibroScan<span class="elsevierStyleSup">&#174;</span> did not detect liver disease&#46; Liver biopsy was considered&#44; but at present&#44; not indicated&#44; due to the benefit&#47;risk balance&#46; She reported no risk factors for HCV infection&#44; although her medical history showed vaginal papillomavirus&#46;</p><p class="elsevierStylePara">The clinical progression has been stable for four years of follow-up&#46;</p><p class="elsevierStylePara">Lastly&#44; microscopic haematuria with minimal glomerular lesions of mesangial predominance was diagnosed in a patient with occult HCV and persistently high levels of ASLO&#44; IgM and IgE without&#44; so far&#44; confirming a causal relationship&#46;<span class="elsevierStyleSup">3</span> This is the first patient to be diagnosed with occult HCV with a non-dialysis nephropathy&#44; although the causality or relationship between factors remains to be determined&#46; Given the history of bronchial asthma with the possibility of requiring immunosuppressant treatment&#44;<span class="elsevierStyleSup">4</span> monitoring of the viral load by ultrasensitive techniques described<span class="elsevierStyleSup">1&#44;2</span> is considered to be important&#46;</p><p class="elsevierStylePara">We wish to thank Dr&#46; Guillermina Barril for his knowledge about the classical occult C virus in patients on haemodialysis&#44; which has allowed us to extrapolate this diagnosis to the rest of the patients with nephropathy&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11807&#95;16025&#95;49126&#95;en&#95;f111807&#46;jpg" class="elsevierStyleCrossRefs"><img src="11807_16025_49126_en_f111807.jpg" alt="Renal biopsy&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Renal biopsy&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11807&#95;16025&#95;49127&#95;en&#95;f211807&#46;jpg" class="elsevierStyleCrossRefs"><img src="11807_16025_49127_en_f211807.jpg" alt="Renal Biopsy 2&#46;"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Renal Biopsy 2&#46;</p>"
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