Persistent Mixed Cryoglobulinemia Despite Successful Treatment of Hepatitis C, Aggressive B-Cell–Directed Therapies, and Long-term Plasma Exchanges

Pelletier, Karyne; Royal, Virginie; Mongeau, Frédéric; Meunier, Rosalie-Sélène; Dion, Dominique; Jao, Kevin; Troyanov, Stéphan

doi:10.1016/j.ekir.2019.04.022

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…Of those patients with renal involvement (Table 2) 25% have complete resolution of GN and 55% have partial improvement in GN following therapy with DAA [41][42][43][44][45][46][47][48][49]50 & ,51-55, 57,58,61]. Although > 95% of patients with HCV-associated MCS achieve SVR and achieving SVR is associated with higher complete MCS remission (OR 20.76, 95% CI 6.73-64.05) [62]; clinical and immunological response do not universally correlate with SVR, occasionally lagging behind in time and some patients experience relapses or new onset MCS despite achieving SVR [35,49,53,54,57,58,61,[63][64][65][66][67].…”

Section: Hepatitis C Virus-associated Cryoglobulinemic Vasculitis And...mentioning

confidence: 99%

Progress in hepatitis C virus management in chronic kidney disease

Cohen‐Bucay

Francis

Gordon

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewThe current review highlights advances in the use of direct-acting antiviral (DAA) agents in the treatment of hepatitis C virus (HCV) in chronic kidney disease (CKD) stages G4-5, end-stage renal disease, and kidney transplantation. The use of DAA to facilitate kidney transplantation of HCV negative recipients with kidneys from HCV-infected donors and in the management of HCV-related cryoglobulinemia are also reviewed.Recent findingsDAA treatment results in rates of viral clearance (sustained virological response or SVR) of 90–100% in all studied CKD populations, comparable to SVR rates in the general population. DAA treatment allows safe and effective transplantation of HCV viremic kidneys into uninfected recipients.SummaryThe high SVR results achieved with DAA allow successful treatment of previously under-treated CKD populations, and encouraged innovative interventions such as the use of HCV-infected donor kidneys to uninfected kidney transplant recipients.

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Section: Hepatitis C Virus-associated Cryoglobulinemic Vasculitis And...mentioning

confidence: 99%

Progress in hepatitis C virus management in chronic kidney disease

Cohen‐Bucay

Francis

Gordon

2021

Current Opinion in Nephrology &Amp; Hypertension

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“…HCV binding to the surface of B cells induces clonal memory B-cell proliferation, reducing the activation threshold and causing widespread autoantibody production, mostly of IgM with RF activity toward anti-HCV IgG. Considering the pathogenesis of MC, different therapeutic strategies have been developed in recent years and are available for patients suffering from this vasculitis [114] , [115] . Therapeutic approaches may be etiologic (the eradication of viral infection conditioning the response of the immune system) and/or pathogenetic (reducing the abnormal response of the immune system of the host).…”

Section: Introductionmentioning

confidence: 99%

“…In these cases, rituximab seems to be the best option as an anti-human CD20 monoclonal antibody targeting B cells for reducing disease activity and preventing vasculitis flares. In addition, plasma exchanges to remove cryoglobulins may be indicated in severe cases [115] . The development of a dangerous immune complex-mediated glomerulonephritis represents worsening evolution of the immunologic disorder initially triggered by HCV infection [119] that could impair renal function.…”

Section: Introductionmentioning

confidence: 99%

Cryoglobulins: Identification, classification, and novel biomarkers of mysterious proteins

Napodano

Gulli²,

Rapaccini

et al. 2021

Advances in Clinical Chemistry

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Cryoglobulins consist of serum immunoglobulins that precipitate below 37°C and resolubilize upon warming. The clinical triad of cryoglobulinemia usually includes purpura, weakness, and arthralgia. Cryoglobulinemic syndrome, clinically defined as a systemic vasculitis, is associated with chronic infection with hepatitis C virus (HCV) and autoimmune disorders and can evolve into B-cell malignancies. While the current literature about HCV-associated cryoglobulinemia is not very limited, little is known about the immunologic and serologic profiles of affected patients. Therefore, comprehension of the pathogenetic mechanisms underlying cryoprecipitation could be very helpful. Due to the persistence of viral antigenic stimulation, biomarkers to use after the worsening progression of HCV infection to lymphoproliferative and/or autoimmune diseases are widely needed. Laboratory methods used to detect and characterize low concentrations of cryoprecipitates and immunotyping patterns could improve patient management. The most critical factor affecting cryoglobulin testing is that the pre-analytical phase is not fully completed at 37°C.

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“…In addition, direct-acting antiviral agents (DAAs) have been used for the last decade to improve the clearance of HCV ( 7 ). Although these treatments are expected to improve the clinical outcomes of cryoglobulinemia, several cases of treatment failure or relapse after rituximab and DAAs have recently been reported ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

The Successful Treatment of a Case of HCV-associated Cryoglobulinemic Glomerulonephritis with Rituximab, Direct-acting Antiviral Agents, Plasmapheresis and Long-term Steroid Despite Serologically Persistent Cryoglobulinemia

et al. 2021

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Novel treatments with rituximab or direct-acting antiviral agents (DAAs) were expected to improve the clinical outcomes of hepatitis C virus (HCV)-associated cryoglobulinemia in the last decade. Recently, however, persistent cases of cryoglobulinemia have been reported, and the ideal approach to treating such cases has not been established. We herein report a case of the successful treatment of HCV-associated cryoglobulinemic glomerulonephritis with rituximab, DAAs, occasional plasmapheresis and long-term steroid, with the patient's renal function and proteinuria improving over the long term despite serologically persistent cryoglobulinemia. This case suggests the efficacy of combination treatment with rituximab, DAAs, occasional plasmapheresis and long-term steroid for persistent cryoglobulinemia.

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Persistent Mixed Cryoglobulinemia Despite Successful Treatment of Hepatitis C, Aggressive B-Cell–Directed Therapies, and Long-term Plasma Exchanges

Cited by 9 publications

References 11 publications

Progress in hepatitis C virus management in chronic kidney disease

Progress in hepatitis C virus management in chronic kidney disease

Cryoglobulins: Identification, classification, and novel biomarkers of mysterious proteins

The Successful Treatment of a Case of HCV-associated Cryoglobulinemic Glomerulonephritis with Rituximab, Direct-acting Antiviral Agents, Plasmapheresis and Long-term Steroid Despite Serologically Persistent Cryoglobulinemia

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