Fludarabine treatment of cryoglobulinemic glomerulonephritis.
Three patients (one hepatitis C positive) presented with renal insufficiency and nephrotic-range proteinuria resulting from mixed cryoglobulinemia and glomerulonephritis. All three patients received two to four cycles of intravenous fludarabine (each cycle consisted of 25 to 50 mg/d for 4 to 5 days). All patients responded to therapy with a decrease in proteinuria, increase in serum albumin, and decrease in serum creatinine. This response was evident by 2 months and persisted for 2 to 5 years. In two patients, this response was accompanied by disappearance of cryoglobulins, at least transiently. One patient developed tuberculosis with neutropenia. Transient blindness and neutropenia were seen in another patient. These results suggest that fludarabine may be a useful treatment in cryoglobulinemia with glomerulonephritis, although its use may be accompanied by side effects.
Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, USA.
Jordan L
JL
Rosenstock
Leonard
L
Stern
William H
WH
Sherman
Gerald B
GB
Appel
Jai
J
Radhakrishnan
D000328:Adult; D003449:Cryoglobulinemia / Q000188:drug therapy* / Q000821:virology; D018572:Disease-Free Survival; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D015432:Glomerulonephritis, Membranoproliferative / Q000188:drug therapy* / Q000821:virology; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D019562:Viral Load
D012367:RNA, Viral; D014740:Vidarabine; C024352:fludarabine