title: Treatment of hepatitis C-related kidney disease.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection has been associated with a large spectrum of glomerular lesions in both native and transplanted kidneys. The most common HCV-associated renal disease is type I membranoproliferative glomerulonephritis usually, but not invariably, in the context of type II mixed cryoglobulinemia (MC). HCV infection is also the major cause of MC, a systemic vasculitis characterized by involvement of small and, less frequently, medium-sized vessels. Conflicting data exist on the treatment of HCV-associated glomerular disease.
  
  
  METHODS
  This review examines the drugs used for management of HCV-related kidney disease and discusses current and new strategies. All literature concerning treatment of HCV-associated kidney disease has been retrieved by electronic (Medline) and manual searches.
  
  
  CONCLUSIONS
  Various approaches have been recommended for the treatment of HCV-related glomerular disease, including immunosuppressive therapy (corticosteroids, cytotoxic agents and mAbs) and antiviral therapy. These regimens should be considered according to the level or proteinuria and kidney failure. Immunosuppressive agents are recommended in patients with nephrotic syndrome and/or rapidly progressive kidney failure. Antiviral treatment based on IFN and/or ribavirin or triple antiviral therapy (PEGylated-IFN/ribavirin/telaprevir or boceprevir) has been adopted in patients with moderate proteinuria and slow loss of kidney failure; however, the number of patients enrolled was small. Some patients with HCV-related cryoglobulinemic glomerulonephritis have been treated with rituximab but some issues about its role remain to be clarified. The antiviral treatment of HCV-related glomerular disease is expected to improve in the near future with new agents provided with greater efficacy and safety. However, the affordability of these drugs remains a pivotal issue, particularly in low-income countries.
authors.affiliation: Maggiore Hospital, Division of Nephrology, IRCCS Foundation , Pad. Croff, Via Commenda 15, 20122, Milano , Italy +39 2 5503 4553 ; +39 2 5503 4550 ; fabrizi@policlinico.mi.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabrizi
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Donato
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003449:Cryoglobulinemia / Q000188:drug therapy / Q000209:etiology; D004359:Drug Therapy, Combination; D015432:Glomerulonephritis, Membranoproliferative / Q000188:drug therapy / Q000209:etiology; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D051437:Renal Insufficiency / Q000188:drug therapy / Q000209:etiology
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents
keywords: chronic kidney disease; glomerulonephritis; hepatitis C virus; interferon; ribavirin