The Case | Microhematuria in a patient with beta-thalassemia major: a casual or a causal association?

Make your diagnosis: A 42-year-old woman, with transfusion-dependent thalassemia major (CD39/CD39) since 1 year of age, seeks nephrological attention for microhematuria. Her medical history includes most of the long-term problems known to occur in long-standing beta-thalassemia: she is HCV positive (genotype 1b), with HCV-related chronic liver disease with type III cryoglobulinemia and arthritis (treated with steroids and cyclosporine A, and later switched to methotrexate); she also developed steroid-induced diabetes and hypogonadism because of iron overload, and thalassemia-related osteoporosis (moderate-severe reduction of the bone density) with a possible steroid-related component; she underwent splenectomy at the age of 17 years. She complained of two episodes of renal colic in the past 5 years without stone passing.