<prompt> 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 -PSGNEssential mixed cryoglobulinemiaMembrano proliferative glomerulonephritisFocal segmental glomerulosclerosis  <response>: Essential mixed cryoglobulinemia is characterized by joint pains and swelling ahritis, enlargement of the spleen, skin vasculitis with purplish patches, and nerve and kidney disease. This can lead to recurrent pain in the abdomen, hea attack, and bleeding in the lungs Essential mixed cryoglobulinemia is treated with combinations of medications which reduce inflammation and suppress the immune system. Medications used include nonsteroid antiinflammatory drugs ibuprofen, aspirin, and others, steroids prednisone, prednisolone, cyclophosphamide Cytoxan, chlorambucil Leukeran, and azathioprine Imuran. Plasmapheresis hemapheresis, a procedure whereby the bloods serum is filtered to remove the cryoglobulins, is also performed for severe symptoms. Ref Harrison20th edition pg 287 