title: Delayed spontaneous resolution of nephrotic syndrome in a patient with hepatitis C virus-associated membranoproliferative glomerulonephritis.
abstract: Treatment with antiviral and/or immunosuppressive therapy is considered the standard care in patients with hepatitis C virus (HCV)-associated membranoproliferative glomerulonephritis (MPGN). However, even with an adequate therapy, a favourable response is not always guaranteed. In patients with HCV-associated MPGN, a delayed spontaneous remission of nephrotic syndrome is rare. We present here one such case. Our patient refused antiviral (and immunosuppressive) therapy throughout the course of his illness and was thus managed symptomatically. More than 8 months after presentation, an unexpected gradual resolution of his nephrotic syndrome was noted. The urine protein/creatinine ratio decreased from ~16 000 mg/g of creatinine on presentation to 500 mg/g of creatinine in the 12th month. This was however not accompanied by resolution of HCV or cryoglobulinaemic activity. Our case demonstrates the possibility of a delayed spontaneous remission occurring in this disease. This must be considered when weighing treatment options in such patients.
authors.affiliation: Department of Medicine, St. Luke's-Roosevelt Hospital Center , Columbia University College of Physicians and Surgeons , New York, NY USA.
authors.forename: Gagangeet
authors.initials: G
authors.lastname: Sandhu
authors.affiliation: Department of Pathology , Columbia University College of Physicians and Surgeons , New York, NY , USA.
authors.forename: M Barry
authors.initials: MB
authors.lastname: Stokes
authors.affiliation: Department of Nephrology, St. Luke's-Roosevelt Hospital Center , Columbia University College of Physicians and Surgeons , New York, NY USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Meisels
keywords: hepatitis C virus; membranoproliferative glomerulonephritis; nephrotic syndrome; spontaneous delayed resolution