Antiviral therapy for HCV-associated cryoglobulinemic glomerulonephritis

Case report and review of the literature

Fabrizio Fabrizi, Giovanni Battista Fogazzi, Donata Cresseri, Patrizia Passerini, Paul Martin, Maria Francesca Donato, Maria Grazia Rumi, Piergiorgio Messa

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

We describe the case of a 51-year-old woman with HCV-associated cryoglobulinemic glomerulonephritis (GN). She presented mild deterioration of kidney function, non-nephrotic proteinuria, and active urinary sediment. Kidney biopsy showed features of membranoproliferative changes with some sclerosis. Sustained viral response (SVR) was obtained by 6 months of antiviral therapy (peg-IFN-α2a plus ribavirin). SVR was linked with improvement of kidney function and remission of proteinuria. Clinical and virological remission persists over a 25-month follow-up. This case report emphasizes efficacy and safety of antiviral treatment of HCV-associated glomerulonephritis-preliminary but encouraging results exist. We identified by systematic review of the literature 9 studies (156 unique patients); the pooled estimate of frequency of sustained virological response after IFN-based therapy was 0.49 (95% confidence interval, CI: 0.21, 0.77; p < 0.0005; random effects model). Heterogeneity was found (I2 = 98.9%, p < 0.0001). Two possible regimens should be considered for the treatment of HCV-associated cryoglobulinemic GN according to the clinical presentation. Immunosuppressive therapy is recommended for HCV-related kidney disease having aggressive course, and recent evidence supports rituximab (RTX) use with a reduced exposure to corticosteroids. We identified six studies (66 unique patients) on RTX therapy for HCV-associated kidney disease; at the end of RTX therapy, the pooled estimate of the mean decrease in proteinuria was 1.4 g/24 h (95% CI: 0.75, 2.05, p < 0.001); The p test for heterogeneity gave a value of 0.94 (I2 = 0). Several questions related to RTX use remain. HCV-induced GN is uncommon among CKD patients of developed countries, and this clearly hampers prospective controlled clinical trials aimed to evaluate efficacy and safety of antiviral or immunosuppressive therapy in this population.

Original languageEnglish
Pages (from-to)687-693
Number of pages7
JournalKidney and Blood Pressure Research
Volume35
Issue number6
DOIs
StatePublished - Feb 1 2013

Fingerprint

Glomerulonephritis
Antiviral Agents
Proteinuria
Kidney Diseases
Therapeutics
Immunosuppressive Agents
Kidney
Safety
Ribavirin
Controlled Clinical Trials
Sclerosis
Developed Countries
Adrenal Cortex Hormones
Confidence Intervals
Biopsy
Rituximab
Population

Keywords

  • Cryoglobulinemia
  • Glomerulonephritis
  • Hepatitis C
  • Interferon
  • Rituximab

ASJC Scopus subject areas

  • Nephrology
  • Cardiology and Cardiovascular Medicine

Cite this

Antiviral therapy for HCV-associated cryoglobulinemic glomerulonephritis : Case report and review of the literature. / Fabrizi, Fabrizio; Fogazzi, Giovanni Battista; Cresseri, Donata; Passerini, Patrizia; Martin, Paul; Donato, Maria Francesca; Rumi, Maria Grazia; Messa, Piergiorgio.

In: Kidney and Blood Pressure Research, Vol. 35, No. 6, 01.02.2013, p. 687-693.

Research output: Contribution to journalArticle

Fabrizi, Fabrizio ; Fogazzi, Giovanni Battista ; Cresseri, Donata ; Passerini, Patrizia ; Martin, Paul ; Donato, Maria Francesca ; Rumi, Maria Grazia ; Messa, Piergiorgio. / Antiviral therapy for HCV-associated cryoglobulinemic glomerulonephritis : Case report and review of the literature. In: Kidney and Blood Pressure Research. 2013 ; Vol. 35, No. 6. pp. 687-693.
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