Mixed Cryoglobulinemia and Membranoproliferative Glomerulonephritis Associated with Hepatitis C Virus Infection

Lopes, Edmundo Pessoa de Almeida; Lopes, Lucila; Silva, Antônio Augusto Moura da

doi:10.7326/0003-4819-125-9-199611010-00030

Cited by 14 publications

(9 citation statements)

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“…Patients should receive concurrent therapy for the underlying HCV infection after glomerulonephritis stabilization. However, poor outcomes have been reported in most adult patients with HCV-associated MPGN, with progression to renal failure due to a high recurrence rate after discontinuation of immunosuppressive therapy [2,3]. Treatment of the underlying HCV infection has recently rapidly evolved with the introduction of direct-acting antivirals (DAAs), wherein curative sustained viral response (SVR) rates have been achieved for HCV genotype 1, with the added benefit of fewer drug adverse effects [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

A case of rapid amelioration of hepatitis C virus-associated cryoglobulinemic membranoproliferative glomerulonephritis treated by interferon-free directly acting antivirals for HCV in the absence of immunosuppressant

et al. 2016

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Mixed cryoglobulinemic syndrome, which is a systemic vasculitis characterized by the immune complex deposition in small-and medium-sized arteries and most often due to chronic hepatitis C virus (HCV) infection, sometimes clinically manifests as refractory glomerulonephritis or nephritic syndrome. Patients with mixed cryoglobulinemic nephropathy who have a rapidly progressive glomerulonephritis should receive immunosuppressive therapy. After disease stabilization, patients should receive concurrent therapy for the underlying HCV infection. The standard therapy of a chronic HCV infection is IFN monotherapy or IFN combined with ribavirin; however, after the introduction of direct-acting antivirals (DAAs), the standard therapy for patients with HCV genotype 1 has dramatically changed. We report a case of HCV-associated cryoglobulinemic membranoproliferative glomerulonephritis (MPGN) successfully treated by daclatasvir and asunaprevir, which are IFN-free DAAs for HCV, in combination with angiotensin II receptor blocker without immunosuppressive therapy. The patient developed severe nephrotic syndrome with progressive kidney dysfunction. Blood examination revealed a high copy number of HCV-RNA (6.4 log IU/mL, type 1), cryoglobulinemia, paraproteinemia of IgM-j, and hypocomplementemia. Histological analysis showed MPGN type 1. These findings were compatible with those observed in HCV-associated cryoglobulinemic MPGN. This case offers original evidence for the application of newer generation of IFN-free DAAs in the treatment of HCV-associated cryoglobulinemic nephropathy.

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Section: Introductionmentioning

confidence: 99%

A case of rapid amelioration of hepatitis C virus-associated cryoglobulinemic membranoproliferative glomerulonephritis treated by interferon-free directly acting antivirals for HCV in the absence of immunosuppressant

et al. 2016

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“…23,24 Johnson et al 23 reported that the administration of IFN to 14 patients with HCVassociated nephritis improved proteinuria, but they observed a relapse of nephritis in association with HCV reexpression after the end of IFN therapy in many patients. 23 Recently, IFN and ribavirin combination therapy, which shows a low relapse rate, has been tested.…”

Section: Renal Impairmentsmentioning

confidence: 97%

Hepatitis C as a systemic disease: virus and host immunologic responses underlie hepatic and extrahepatic manifestations

2007

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“…La leucopenia y la trombocitopenia son pocos comunes (2). Las enzimas hepáticas suelen estar elevadas (2,14,24). El factor reumatoideo suele ser positivo en CM, y se asocia a la presencia de púrpura, señalándose que es necesaria su presencia para qué existan lesiones vasculíticas en piel (11,14).…”

Section: Discusionunclassified

“…Esto se confirma con el hecho que al descontinuar el tratamiento con interferon se ha observado una recaída en la viremia y un empeoramiento de la crioglobulinemia (7), mientras que la remisión coincide con la desaparición del ARN viral en suero (28). Otro reporte que enfatiza importancia de la terapéutica antiviral, es el de un paciente con CM tipo II e infección por HCV que respondió a terapia única con Ribavirina -600 -1200 mg/día por 6 meses- (24).…”

Section: Discusionunclassified

Crioglobulinemia mixta asociada a infección por hepatitis C y gangrena de miembros inferiores.

Rio

Raez

2013

Rev Med Hered

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SUMMARYCryoglobulinemia is a systemic disorder in which the blood contains inmunoglobulins that reversibly precipitate in the cold, giving rise to immune complex deposition that may cause small vessel vasculitis. A strong association with Hepatitis C has been made in the latest years. We describe a patient with hepatitis C and Cryoglobulinemia who wazzu developed one of the most severe crises with clinical manifestations of gangrene in feet and upper extremities. Patient ended with amputation of the lower limbs. His life was saved with plasmapheresis, use of frozen plasma, steroids, heparin and alfa interferon. In this article we report the case and we do a review of the literature on cryoglobulinemia. (Rev Med Hered 1997;8:183-188).

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Mixed Cryoglobulinemia and Membranoproliferative Glomerulonephritis Associated with Hepatitis C Virus Infection

Cited by 14 publications

References 0 publications

A case of rapid amelioration of hepatitis C virus-associated cryoglobulinemic membranoproliferative glomerulonephritis treated by interferon-free directly acting antivirals for HCV in the absence of immunosuppressant

A case of rapid amelioration of hepatitis C virus-associated cryoglobulinemic membranoproliferative glomerulonephritis treated by interferon-free directly acting antivirals for HCV in the absence of immunosuppressant

Hepatitis C as a systemic disease: virus and host immunologic responses underlie hepatic and extrahepatic manifestations

Crioglobulinemia mixta asociada a infección por hepatitis C y gangrena de miembros inferiores.

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