[Membranoproliferative glomerulonephritis in patients with cryoglobulinemia complicating hepatitis C virus: report of 11 cases].
BACKGROUND
Membranoproliferative glomerulonephritis in patients with cryoglobulinemia complicating hepatitis C virus have yet been reported. Although, it remains controversial, antiviral treatment seems to be able to improve the outcome of glomerulonephritis.


OBJECTIVE
The objectives of the study were to analyze characteristics of this association and to report literature data and newness treatment.


METHODS
It's a retrospective study including 11 patients with membranoproliferative glomerulonephritis, hepatitis C virus and mixed cryoglobulinemia. Hepatitis C virus antibodies was identified by ELISA technique. Hepatitis C virus genotype was identified in one patient. Cryoglobulins were isolated from sera of all patients at 37 degrees Celsius.


RESULTS
Patients were 3 men and 8 women with a mean age of 51.9 +/- 15.5 years. Between the 11 patients, 7 had hypertension, 9 had nephrotic syndrome and 10 had chronic renal failure. Renal biopsy showed membranoproliferative glomerulonephritis lesions in all cases with fibrinoid thrombi in 8 cases. Six patients had chronic liver disease. Liver biopsy was performed in 4 patients, showing histological feature compatible with chronic active hepatitis in 2 cases. No patient had antiviral therapy. Renal failure was stable in 5 cases and progressed in 6 cases with end stage renal failure in 3 of them. One patient died, 4 months after diagnosis, because of severe pulmonary involvement in cryoglobulinemic vasculitis. In literature, treatment is dominated by antiviral therapy composed first by Interferon Alpha alone. Combination therapy associating Interferon and Ribavirin was recently used in renal involvement; it is clearly more effective than interferon alpha alone.


CONCLUSIONS
Hepatitis C virus detection should be performed when membranoproliferative glomerulonephritis is associated with cryoglobulinemia. Antiviral treatment should be more widely used in Tunisia to evaluate his effect on renal involvement
Service de Médecine Interne A Hôpital Charles Nicolle, Tunisie.
Lilia
L
Ben Fatma
Fethi
F
Ben Hamida
Raja
R
Aoudia
Rym
R
Goucha
Hayet
H
Kaaroud
Soumaya
S
Béji
Samia
S
Barbouch
Hafedh
H
Hedri
Ezzeddine
E
Abderrahim
Fethi
F
Elyounsi
Taieb
T
Ben Abdallah
Fatma
F
Ben Moussa
Adel
A
Kheder
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D003449:Cryoglobulinemia / Q000150:complications*; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies