Treatment of hepatitis C-virus-related glomerulonephritis.

Department of Nephrology, Dialysis, and Multiorgan Transplantation, CHU Rangueil, Toulouse University Hospital, Toulouse, France.
Kidney International (Impact Factor: 8.52). 03/2006; 69(3):436-9. DOI: 10.1038/
Source: PubMed

ABSTRACT Membranoproliferative glomerulonephritis (MPGN) associated with type II cryoglobulinemia is the predominant type of hepatitis C virus (HCV)-related glomerulonephritis. The blockade of the renin-angiotensin system, as well as a combined anti-HCV therapy that associates standard or pegylated alpha-interferon with ribavirin, are mandatory in all patients experiencing an HCV-related glomerulonephritis. In patients with nephrotic-range proteinuria and/or progressive renal failure, immunosuppressive therapy is necessary. Rituximab, the monoclonal anti-CD20 antibody that selectively targets the B cells, seems to be as least as efficient as cyclophosphamide. Because it is also better tolerated, it should be preferred to cyclophosphamide. During the acute phase, plasmapheresis and steroid pulses can be used. However, future prospective, controlled, and randomized studies are still required to establish evidence-based guidelines to treat HCV-related glomerulopathies.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Hepatitis C virus (HCV) affects 1.8% of the American population, and approximately 38% of patients with HCV will manifest symptoms of at least 1 extrahepatic manifestation during the illness. Renal disease, neuropathy, lymphoma, and Sjögren syndrome with or without mixed cryoglobulinemia are all strongly associated with HCV infection. Porphyria cutanea tarda and diabetes have also been linked to HCV. Most extrahepatic manifestations of chronic HCV infection are immunological, and the chronic infection seems to be necessary for their development. The molecular study of the unique way in which the HCV virus interacts with the human immune system is beginning to provide plausible explanations of the pathogenic role of HCV in some of these syndromes, but many pathogenetic links remain completely obscure.
    The American Journal of the Medical Sciences 04/2003; 325(3):135-148. DOI:10.1097/00000441-200303000-00006 · 1.52 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: chronic hepatitis C is a major health problems in our country, where it causes a major burden of illness for the patients and community, however nephropathy is a common extrahepatic manifestation for this diseases whether associated with cryoglobinemia or not; moreover, the standard treatment of chronic HCV infection now is the combined peg-interferon and ribavirin. Aim of the work: This study was conducted to estimate the prevalence of HCV-related nephropathy and cryoglobinemia in our setting and its response to the standard treatment of chronic hepatitis C namely ( peg-interferon and ribavirin). Patient and method: eighty-four patients with chronic hepatitis C who were eligible for therapy with peg-interferon and ribavirin were tested for nephropathy (presence of proteinuria and/or heamaturia) and presence of cryoglobinemia before treatment, after 12 weeks, at end of treatment(48 weeks), and 6months after end of treatment. Results: the prevalence of nephropathy before treatment was38.1% and prevalence of cryoglobinemiawas 34.5% where both decreased significantly to 16.7%. however nephropathy with cryoglobinemia more significantly responded to treatment while those with nephropathy and no cryoglobinema showed insignificant decrease from 7.1% to only 6%. As regard the virological response EVR was 67.8%, but SVR was 47.6%. Conclusion: HCV-related nephropathy associated with cryoglobinemia responds significantly to standard therapy for HCV with beg-interferon and ribavirin
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess whether the correction dose recommended by the summary of product characteristics was adequate and to confirm the adequacy of the recommended conversion dosing strategies from shorter-acting erythropoiesis-stimulating agents (ESAs) to continuous erythropoietin receptor activator (C.E.R.A) in anaemic chronic kidney disease (CKD) patients in the clinical setting. This was a 12-month, multicenter, prospective, observational study in anaemic CKD patients on haemodialysis and not on dialysis receiving C.E.R.A (at least one dose). A total of 227 patients were included (not on dialysis; n = 142; haemodialysis: n = 85). The present analysis was conducted on ESA-na < ve patients (not on dialysis: n = 31) and patients switched from other ESA (not on dialysis: n = 63; haemodialysis: n = 57). Both on and not on dialysis patients switched from other ESA received lower starting C.E.R.A doses than those recommended, and remained stable during the 12-month period. The higher the previous ESA dose was, the more beneficial the C.E.R.A dose conversion factor was. The proportion of patients with stable haemoglobin within the target range (11-13 g/dL) did not vary during the 12-month period both in nondialysis CKD patients and in those undergoing dialysis [baseline: 42 (66.7 %) and 34 (59.6 %); month 6: 21 (55.3 %) and 26 (50.0 %); month 12: 20 (64.5 %) and 25 (69.4 %), respectively]. In na < ve patients, the mean weight-adjusted C.E.R.A dose during the study (1.19 +/- A 0.49 A mu g/kg/month) was similar to the recommended one. C.E.R.A was well tolerated. Conversion from shorter-acting ESAs to C.E.R.A doses lower than those recommended can efficiently maintain target haemoglobin levels both in nondialysis and haemodialysis CKD patients, particularly when switching from higher ESA doses. A monthly C.E.R.A dose of 1.2 A mu g/Kg seems adequate for anaemia correction.
    International Urology and Nephrology 08/2014; 46(10). DOI:10.1007/s11255-014-0800-4 · 1.29 Impact Factor


Available from