Membranoproliferative Glomerulonephritis, Type II Cryoglobulinemia and Triple Therapy for Hepatitis C: A Case Series and Review of the Literature

Humphries, Kevin; Darling, Jama M.; Barritt, A. Sidney

doi:10.1007/s10620-014-3085-7

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…In the setting of cirrhosis, AKI can be caused by either chronic structural kidney disease or functional renal failure, depending on the type of liver disease. For example, non‐alcoholic fatty liver disease and metabolic syndrome are associated with chronic kidney disease (CKD) , while type II cryoglobulinemia is frequently seen in chronic HCV infection and can lead to membranoproliferative glomerulonephritis . In contrast, HRS is more common in ALD according to a pooled analysis that found alcohol‐related cirrhosis as the underlying aetiology in 57% of cases .…”

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confidence: 99%

Reduced impact of renal failure on the outcome of patients with alcoholic liver disease undergoing liver transplantation

Cheong

Galanko

Arora

et al. 2016

Liver International

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Background and Aims Pre-transplant renal failure is commonly reported to be a poor prognostic indicator affecting survival after liver transplantation (LT). However, whether the impact of renal failure on patient outcome varies according to the etiology of the underlying liver disease is largely unknown. Methods We investigated the association between renal failure at the time of LT and patient outcome in patients with alcoholic liver disease (ALD)(n=6,920), nonalcoholic steatohepatitis (NASH)(n=2,956) and hepatitis C (HCV) (n=14,922) using the United Network for Organ Sharing (UNOS) database between February 2002 and December 2013. A total of 24,798 transplant recipients were included. Results The presence of renal failure was more frequently seen in patients with ALD (23.95%) and NASH (23.27%) compared to patients with HCV (19.38%)(p<0.001). In multivariate analysis, renal failure was an independent predictor of poor survival. Renal failure showed detrimental effect on patient survival in the overall series (HR=1.466, p<0.0001). Importantly, the impact of renal failure was less marked in patients with ALD (HR=1.31, p<0.0001) than in patients with NASH (HR=1.73, p<0.0001) or HCV (HR=1.52, p<0.0001). Despite a higher Model for End-stage Liver Disease (MELD) score at the time of LT, ALD patients with renal failure had better long-term prognosis than non-ALD patients. Conclusions Renal failure at the time of LT conferred a lower patient and graft survival post-LT. However, renal failure has less impact on the outcome of patients with ALD than that of patients with non-alcoholic liver disease after LT.

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confidence: 99%

Reduced impact of renal failure on the outcome of patients with alcoholic liver disease undergoing liver transplantation

Cheong

Galanko

Arora

et al. 2016

Liver International

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“…Few studies report the use of DAAs in cryoglobulinemia or vasculitis. Humphries et al 74 reported a case of cryoglobulinemic vasculitis manifesting as membranoproliferative glomerulonephritis (MPGN) and skin ulcers that was treated with telaprevir, pegIFN and RBV concurrent with methylprednisolone and plasmapheresis. SVR was achieved, but the MPGN progressed to end-stage renal disease by 7 weeks after treatment.…”

Section: Resultsmentioning

confidence: 99%

“… 75 In a patient undergoing plasmapheresis and 2 days of high-dose methylprednisolone for MPGN and skin ulcers secondary to cryoglobulinemia, SVR was achieved but renal dysfunction progressed to end-stage renal disease and severe anemia required transfusions, erythropoietin and interruption of IFN and RBV. 74 …”

Section: Resultsmentioning

confidence: 99%

Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

Ooka

Lim

2016

JCTH

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With 185 million people chronically infected globally, hepatitis C is a leading bloodborne infection. All-oral regimens of direct acting agents have superior efficacy compared to the historical interferon-based regimens and are significantly more tolerable. However, trials of both types of regimens have often excluded patients on immunosuppressive medications for reasons other than organ transplantation. Yet, these patients—most often suffering from malignancy or autoimmune diseases—could stand to benefit from these treatments. In this study, we systematically review the literature on the treatment of hepatitis C in these neglected populations. Research on patients with organ transplants is more robust and this literature is reviewed here non-systematically. Our systematic review produced 2273 unique works, of which 56 met our inclusion criteria and were used in our review. The quality of data was low; only 3 of the 56 studies were randomized controlled trials. Sustained virologic response was reported sporadically. Interferon-containing regimens achieved this end-point at rates comparable to that in immunocompetent individuals. Severe adverse effects and death were rare. Data on all-oral regimens were sparse, but in the most robust study, rates of sustained virologic response were again comparable to immunocompetent individuals (40/41). Efficacy and safety of interferon-containing regimens and all-oral regimens were similar to rates in immunocompetent individuals; however, there were few interventional trials. The large number of case reports and case series makes conclusions vulnerable to publication bias. While firm conclusions are challenging, given the dearth of high-quality studies, our results demonstrate that antiviral therapy can be safe and effective. The advent of all-oral regimens offers patients and clinicians greatly increased chances of cure and fewer side effects. Preliminary data reveal that these regimens may confer such benefits in immunosuppressed individuals as well. More prospective interventional trials would greatly benefit the many patients with chronic hepatitis C on immunosuppressive therapies.

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“…Nine patients with symptomatic mixed cryoglobulinemic disease (seven with MPGN) and HCV GT1 underwent triple antiviral therapy (pegylated IFN, RBV, and boceprevir [n ¼ 2] or telaprevir [n ¼ 5] or sofosbuvir [n ¼ 2]). 325,335 All patients reached SVR, but serum cryoglobulins persisted in 3 patients; also, the benefits on renal signs were partial. MPGN remitted in 3 patients after further treatment with corticosteroids or corticosteroids plus rituximab.…”

Section: 231mentioning

confidence: 99%

KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease

2019

N&D

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of recommendation statements 108 Chapter 1: Detection and evaluation of HCV in CKD 114 Chapter 2: Treatment of HCV infection in patients with CKD 121 Chapter 3: Preventing HCV transmission in hemodialysis units 130 Chapter 4: Management of HCV-infected patients before and after kidney transplantation 137 Chapter 5: Diagnosis and management of kidney diseases associated with HCV infection 142 Methods for guideline development 151 Biographic and disclosure information 157 Acknowledgments 158 References The development and publication of this guideline were supported by KDIGO. The opinions or views expressed in this professional education supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the International Society of Nephrology or Elsevier. Dosages, indications, and methods of use for products that are referred to in the supplement by the authors may reflect their clinical experience or may be derived from the professional literature or other clinical sources. Because of the differences between in vitro and in vivo systems and between laboratory animal models and clinical data in humans, in vitro and animal data may not necessarily correlate with clinical results.

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Membranoproliferative Glomerulonephritis, Type II Cryoglobulinemia and Triple Therapy for Hepatitis C: A Case Series and Review of the Literature

Cited by 12 publications

References 28 publications

Reduced impact of renal failure on the outcome of patients with alcoholic liver disease undergoing liver transplantation

Reduced impact of renal failure on the outcome of patients with alcoholic liver disease undergoing liver transplantation

Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease

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