Hepatitis C virus–related cryoglobulinemic glomerulonephritis: Long-term remission after antiviral therapy

Rossi, Paolo; Bertani, Tullio; Baio, Piero; Caldara, R.; Luliri, P; Tengattini, F.; Bellavita, Piermario; Mazzucco, Gianna; Misiani, Rocco

doi:10.1046/j.1523-1755.2003.00022.x

Cited by 83 publications

(46 citation statements)

References 22 publications

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“…After discontinuation of therapy, both recurrence of viremia and proteinuria were observed. Other studies (38,39) have demonstrated an improvement in HCV-related renal disease associated with response to treatment, supporting a direct relationship between HCV infection and renal disease.…”

Section: Summary Of Findingsmentioning

confidence: 97%

Hepatitis C Virus Infection and the Prevalence of Renal Insufficiency

Dalrymple

Koepsell²,

Sampson³

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background: Hepatitis C virus (HCV) is associated with pathologic changes in the kidney. However, the association between HCV and renal dysfunction is not well defined.Design, setting, participants, and measurements: This study estimated the prevalence of renal insufficiency among veterans who received care through the Veterans Affairs Puget Sound Health Care System. The study population consisted of veterans who underwent HCV antibody testing between January 1, 1999, and December 31, 2004, and had at least one primary care or medical subspecialty visit and at least one outpatient creatinine measurement within the 18 mo before antibody testing. Veterans were excluded when they had a history of chronic dialysis, creatinine >5 mg/dl, or renal transplantation. Study data were extracted from the electronic medical record. Renal insufficiency was defined as a creatinine level >1.5 mg/dl. Multivariate logistic regression was performed to estimate the risk for renal insufficiency associated with HCV. Among 25,782 eligible veterans, 1928 were HCV antibody positive and 23,854 were HCV antibody negative.Results: Although the proportion with renal insufficiency was lower for antibody-positive versus -negative veterans (4.8 versus 6.0%), after adjustment for age, race, gender, diabetes, and hypertension, HCV-positive veterans had a 40% higher odds for renal insufficiency (odds ratio 1.40; 95% confidence interval 1.11 to 1.76) as compared with HCV-negative veterans.Conclusions: HCV was associated with an increased prevalence of renal insufficiency.

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Section: Summary Of Findingsmentioning

confidence: 97%

Hepatitis C Virus Infection and the Prevalence of Renal Insufficiency

Dalrymple

Koepsell²,

Sampson³

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…In patients with HCV-associated renal disease, sustained virologic responses (SVR) to antiviral therapy have been associated with improvements in renal histology (reduced glomerular inflammation and immune deposits) and in biochemical markers of renal function (49). However, the clinical and histologic improvements are not seen uniformly.…”

Section: Hcv-associated Posttransplantation Glomerulopathiesmentioning

confidence: 98%

“…Treated patients typically demonstrate improvements in renal function and reduced levels of cryoglobulins. Although early reports indicated a high rate of relapse after IFN discontinuation, relapse rates seem to have declined after ribavirin was used in combination with IFN (49,64,124).…”

Section: Management Of Hcv-associated Renal Disease After Transplantamentioning

confidence: 99%

“…Attainment of SVR in dialysis patients would be expected to minimize the risk for long-term complications, both before and after kidney transplantation. Success in treating HCV-related glomerulopathies with antiviral therapy has been reported in nontransplantation patients (49,64). Viral eradication in patients with HCV-associated glomerulopathy may stabilize renal function and prevent recurrent glomerulonephritis in the allograft after renal transplantation (28).…”

Section: Overview Of Hcv Therapymentioning

confidence: 99%

“…Antiviral therapy has been best studied in nontransplant patients with HCV-associated membranoproliferative glomerulonephritis and cryoglobulinemia (50). For patients with mild to moderate disease, antiviral therapy with IFN-␣ (pegylated and nonpegylated forms) and ribavirin is generally considered first-line therapy (49,64,124). Treated patients typically demonstrate improvements in renal function and reduced levels of cryoglobulins.…”

Section: Management Of Hcv-associated Renal Disease After Transplantamentioning

confidence: 99%

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The Kidney Transplant Recipient with Hepatitis C Infection

Terrault

Adey

2007

Clinical Journal of the American Society of Nephrology

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Liver disease secondary to chronic hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in dialysis patients and kidney transplant recipients. Evaluation of patients with chronic HCV infection is warranted to determine stage of disease and the need for HCV therapy. Although combination therapy with interferon (IFN) plus ribavirin is the standard of care for chronic HCV infection, IFN monotherapy is recommended in dialysis patients because ribavirin is contraindicated in the presence of renal failure. The goals of pretransplantation HCV therapy are to decrease the risk for progression of HCV-associated liver disease, stabilize renal function in patients with HCV-related glomerulopathy, and prevent development of HCV-associated renal disease after transplantation. Posttransplantation HCV therapy is generally not recommended because of concerns regarding risk for precipitating acute rejection; however, antiviral therapy may be indicated to treat HCV-related glomerulopathy or prevent progression of chronic hepatitis C in patients with more advanced stages of fibrosis. When treatment is required, restored renal function allows use of combination therapy with IFN and ribavirin. Limitations of current HCV therapy include lack of tolerability and suboptimal response rates. New antiviral agents that can be used in dialysis patients (e.g., ribavirin alternatives) and in the posttransplantation setting (e.g., IFN alternatives) are needed to improve outcomes in these populations.

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