title: Antiviral therapy for HCV-associated cryoglobulinemic glomerulonephritis: case report and review of the literature.
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 (I(2) = 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 (I(2) = 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.
authors.affiliation: Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milan, Italy. fabrizi @ policlinico.mi.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabrizi
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Fogazzi
authors.forename: Donata
authors.initials: D
authors.lastname: Cresseri
authors.forename: Patrizia
authors.initials: P
authors.lastname: Passerini
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Donato
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Rumi
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003449:Cryoglobulinemia / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents