Sandbox:Feham
- Mixed Cryoglobulinemia is a combination of both types II and III.
- Mixed CGs is associated with following conditions:
SLE (systemic lupus erythematous)
Sjogren's syndrome,
HCV
Lymphoproliferative disorders
- SLE (systemic lupus erythematous)
- Sjogren's syndrome,
- HCV
- Lymphoproliferative disorders
- Al the above mentioned disorders can cause excessive production of B-cell which can further lead to selective expansion of Cryoglobulinemia producing B-cell clones.
- In HCV infected patients the HCV complexes such as HCV-IgG, HCV-lipoprotein cause B-cell hyper-proliferation through the CD81 leading to expansion of specific B-cell clones such as WA idiotype or V(H)1-69.
- HCV particles are often found in such patients' serum CG complexes, but, at the same time, CG development in hepatitis C infection does not directly require the HCV virion or its components . In this sense, CG development may, in fact, reflect a normal, expected response to regulate immune complexes in states of chronic immune activation.
- Among patients with HCV infection, the number of circulating T cells with surface markers compatible with a suppressor phenotype may be a feature that differs between patients with cryoglobulinemic vasculitis and those with asymptomatic CG.
- This was illustrated in a study that compared the percentage of "regulatory" T cells in 69 patients with HCV infection who had symptomatic CG with others with asymptomatic HCV infection .
- The mean levels of regulatory T cells were significantly lower in those with symptomatic HCV-associated CG than asymptomatic subjects (2.6 versus 7.4 percent, respectively).
- Whether the diminished proportion of regulatory T cells plays a role in causing vasculitis is uncertain but warrants further exploration.

# Differentiating uremia from other diseases
Uremia and uremic encephalopathy must be differentiated from other diseases that cause personality changes, altered level of consciousness and hand tremors (asterixis). The differentials include the following:
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