The recent availability of effective antiviral agents offers new options in the management of chronic hepatitis C virus (HCV) infection in patients with renal failure. Interferon (IFN) can lead to excellent results in selected patients on dialysis, with long-term remission durable even after renal transplantation. Studies are under way to evaluate the efficacy of pegylated IFNs in individuals with HCV infection and renal insufficiency. Preliminary data encourage cautious ribavirin use in conjunction with IFN therapy in dialysis populations. Randomized trials are warranted, however. HCV has an important pathogenic role in cryoglobulinemia, and treatment of HCV infection may ameliorate organ damage due to cryoglobulinemia. There is no standard, effective therapy for mixed cryoglobulinemic glomerulonephritis, although IFN-alfa, with or without ribavirin, has been used successfully. The use of IFN for HCV-infected patients after renal transplantation is precluded by the high frequency of impairment of the graft, so therapy should be considered prior to transplantation.
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