Interferon-Alpha–Induced Focal Segmental Glomerulosclerosis in Chronic Myelogenous Leukemia

Abstract

Chronic myelogenous leukemia (CML), hepatitis C, and interferon alpha (IFNalpha) have all been associated with renal dysfunction. In this paper we present a patient with the diagnosis of nephrotic syndrome and a known history of hepatitis C who received IFNalpha therapy for newly diagnosed CML. The renal biopsy showed focal segmental glomerulosclerosis, which has only been previously reported in two cases of CML treated with IFNalpha. There have also been two cases of patients with hepatitis C associated with focal segmental glomerulosclerosis. Despite the underlying hepatitis C, this case represents renal abnormalities consistent with IFNalpha therapy for CML.

Collapsing glomerulopathy as a complication of interferon therapy for hepatitis C infection

“…Bremer et al [3] described a patient with chronic myelogenous leukemia (CML) who also had chronic hepatitis C infection and developed acute renal failure and severe nephrotic syndrome after initiation of IFNa therapy. A kidney biopsy revealed features of collapsing FSGS.…”

“…Collapsing FSGS is characterized clinically by nephrotic syndrome and acute renal failure. Prognosis is poor, with rapid progression to end-stage renal disease [3]. We report here a patient with chronic hepatitis C and diabetes, who rapidly progressed to end stage renal disease upon initiation of IFNa therapy for his HCV infection, and his kidney biopsy showed advanced collapsing glomerulopathy.…”

Interferon α sensitisation induced fatal renal insufficiency in a patient with chronic myeloid leukaemia: case report and review of literature: Figure 1

“…That IFNa may induce renal damage has been described previously in six patients treated for hepatitis C. 6 These patients developed nephropathy following IFNa treatment; four had membranoproliferative glomerulonephritis, one had membranous nephropathy, and the last one had focal segmental glomerulosclerosis, all as a result of deposited immune complexes. While renal damage may be less severe in some patients, it can result in an end stage renal dysfunction in others, particularly those treated with high dose IFNa for hepatitis C. 7 A patient with both pre-existing hepatitis C and CML treated with IFNa developed nephrotic syndrome, 8 which may have been precipitated by either the hepatitis C or the IFNa therapy. This patient's renal function worsened rather than improved with IFNa treatment, arguing in favour of IFNa treatment rather than the underlying CML as a precipitating factor.…”

Renal toxicity of therapeutic drugs

“…While mild proteinuria is relatively common in patients treated with interferons, the nephrotic syndrome is rare 43. When it does occur, the biopsies have shown either MCD or FSGS 44 45. Lithium-associated MCD occurs relatively soon after therapy, mostly in the first year, and biopsies have only rarely shown CIN 46.…”