Treatment of hepatitis C-virus-related glomerulonephritis.
Membranoproliferative glomerulonephritis (MPGN) associated with type II cryoglobulinemia is the predominant type of hepatitis C virus (HCV)-related glomerulonephritis. The blockade of the renin-angiotensin system, as well as a combined anti-HCV therapy that associates standard or pegylated alpha-interferon with ribavirin, are mandatory in all patients experiencing an HCV-related glomerulonephritis. In patients with nephrotic-range proteinuria and/or progressive renal failure, immunosuppressive therapy is necessary. Rituximab, the monoclonal anti-CD20 antibody that selectively targets the B cells, seems to be as least as efficient as cyclophosphamide. Because it is also better tolerated, it should be preferred to cyclophosphamide. During the acute phase, plasmapheresis and steroid pulses can be used. However, future prospective, controlled, and randomized studies are still required to establish evidence-based guidelines to treat HCV-related glomerulopathies.
Kamar
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Department of Nephrology, Dialysis, and Multiorgan Transplantation, CHU Rangueil, Toulouse University Hospital, Toulouse, France. alric.L@chu-toulouse.fr
Rostaing
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Alric
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D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents / Q000627:therapeutic use; D003449:Cryoglobulinemia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D004359:Drug Therapy, Combination; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology*; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D011507:Proteinuria / Q000188:drug therapy; D051437:Renal Insufficiency / Q000188:drug therapy; D012084:Renin-Angiotensin System / Q000502:physiology; D012254:Ribavirin / Q000627:therapeutic use; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D012254:Ribavirin; D000069283:Rituximab