title: Daclatasvir/asunaprevir based direct-acting antiviral therapy ameliorate hepatitis C virus-associated cryoglobulinemic membranoproliferative glomerulonephritis: a case report.
abstract: BACKGROUND
  Direct-acting antivirals (DAAs) dramatically improve the treatment of hepatitis C virus (HCV) infections. However, the effects of DAAs on extra-hepatic manifestations such as HCV-associated glomerulonephritis, especially in cases with renal dysfunction, are not well elucidated.
  
  
  METHODS
  A 69-year-old Japanese woman was diagnosed as having chronic hepatitis C, genotype 1b at the age of 55. She presented with hypertension, microscopic hematuria, proteinuria, renal dysfunction, purpura, and arthralgia at the age of 61. She also had hypocomplementemia and cryoglobulinemia. Renal biopsy revealed membranoproliferative glomerulonephritis (MPGN), and she was diagnosed as having HCV-associated cryoglobulinemic MPGN. She declined interferon therapy at the time and was treated with antihypertensive medications as well as oral corticosteroid that were effective in reducing proteinuria. However, when the corticosteroid dose was reduced, proteinuria worsened. She began antiviral treatment with daclatasvir/asunaprevir (DCV/ASV). Clearance of HCV-RNA was obtained by 2 weeks and sustained, and liver function was normalized. In addition, microhematuria turned negative, proteinuria decreased, hypocomplementemia and estimated glomerular filtration rate were improved, whereas cryoglobulinemia persisted. She completed 24 weeks of therapy without significant adverse effects.
  
  
  CONCLUSIONS
  In a case of HCV-associated cryoglobulinemic MPGN with renal dysfunction, DCV/ASV -based DAAs ameliorated microhematuria, proteinuria and renal function without significant side effects.
authors.affiliation: Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan, 036-8562. mshimada@hirosaki-u.ac.jp.
authors.forename: Michiko
authors.identifier: http://orcid.org/0000-0003-2278-6078
authors.initials: M
authors.lastname: Shimada
authors.affiliation: Community Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Endo
authors.affiliation: Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan, 036-8562.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamabe
authors.affiliation: Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan, 036-8562.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan, 036-8562.
authors.forename: Reiichi
authors.initials: R
authors.lastname: Murakami
authors.affiliation: Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan, 036-8562.
authors.forename: Ikuyo
authors.initials: I
authors.lastname: Narita
authors.affiliation: Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan, 036-8562.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D002219:Carbamates; D003449:Cryoglobulinemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D007546:Isoquinolines / Q000008:administration & dosage*; D011759:Pyrrolidines; D013449:Sulfonamides / Q000008:administration & dosage*; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D002219:Carbamates; D007093:Imidazoles; D007546:Isoquinolines; D011759:Pyrrolidines; D013449:Sulfonamides; D014633:Valine; C549273:daclatasvir; C571889:asunaprevir
keywords: Cryoglobulinemia; Direct-acting antivirals; HCV-associated glomerulonephritis; Membranoproliferative glomerulonephritis