Successful steroid treatment in a patient with membranoproliferative glomerulonephritis associated with hepatitis C virus

Sanai, Toru; Watanabe, Izumi; Hirano, Tomohiro; Nakayama, Masaru; Sakai, Hironori; Uesugi, Noriko; Masutani, Kohsuke; Katafuchi, Ritsuko; Hirakata, Hideki; Iida, Mitsuo

doi:10.1007/s11255-007-9322-7

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…Like IFN therapy, steroid therapy is also controversial; however, to our knowledge, no cases of steroid therapy exacerbating cryoglobulinemia have been reported. In many case reports, steroids were the drugs of first choice 39 . Steroids have been expected, on a theoretical basis, to inhibit virus-induced autoimmunity; however, because of the possibility of viral replication due to steroid therapy, patients should be closely observed.…”

Section: Discussionmentioning

confidence: 99%

A Case of Cryoglobulinemic Membranoproliferative Glomerulonephritis Induced by Hepatitis C Virus

et al. 2015

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A 61-year-old man with bilateral purpura of the lower limbs and subsequent edema, was hospitalization after renal dysfunction developed. The presence of hepatitis C virus (HCV) RNA and cryoglobulin and the finding of membranoproliferative glomerulonephritis on renal biopsy led to a diagnosis of HCV-related glomerulonephritis due to cryoglobulinemia. Because of the pre-existence of nephrotic syndrome and the continuously increasing serum level of creatinine, treatment with cryofiltration, interferon, and steroids was started. After 5 cryofiltration sessions, the cryocrit level had decreased to 1% and the levels of serum creatinine and proteinuria had also decreased. However, 3 weeks after the start of treatment, nephrotic syndrome developed again and was accompanied by lower-extremity mononeuropathy and renal dysfunction. Thereafter, the patient showed disorientation, an affective disorder, and delirium, and his condition gradually deteriorated. Radiological examination of the head and examination of the cerebrospinal fluid showed no abnormalities. Despite the withdrawal of the interferon therapy and the reduction of the steroid dose, the patient's conditions remained unchanged, and the level of consciousness deteriorated. Although cryofiltration had beneficial effects and plasma exchange was continuously performed, the patient died on the 74th hospital day. Because of the significant changes due to ventilatory support and hemorrhage associated with disseminated intravascular coagulation, the autopsy findings did not allow us to definitively determine whether the symptoms had been caused by the HCV-related membranoproliferative glomerulonephritis or the interferon therapy or both. We have reported this case to provide insight into whether interferon therapy should be administered for HCV-related membranoproliferative glomerulonephritis with marked neurological symptoms due to cryoglobulinemia.

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Section: Discussionmentioning

confidence: 99%

A Case of Cryoglobulinemic Membranoproliferative Glomerulonephritis Induced by Hepatitis C Virus

et al. 2015

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“…Corticosteroid therapy for HCV-related glomerulonephritis was recommended together with IFN therapy in the KDIGO guidelines [10], and there are several reports of corticosteroid therapy for HCV-related glomerulonephritis [13,14]. In a randomized controlled study, Dammacco et al [15] reported the use of corticosteroid therapy for type II mixed cryoglobulinemia.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus-related glomerulonephritis with acute kidney injury requiring hemodialysis that improved with virus removal and eradication using double-filtration plasmapheresis without interferon

et al. 2014

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A 66-year-old, hepatitis C virus (HCV)-positive woman was admitted to our hospital with oliguria, systemic edema, and rapid deterioration of renal function. Laboratory examination showed increased serum creatinine and decreased serum albumin levels, complement activity, and cryoglobulin positivity. The HCV RNA genotype was found to be 1b, and the viral load was high. Kidney biopsy examination showed type I membranoproliferative glomerulonephritis with capillary deposition of IgM and C3, indicating HCV-related glomerulonephritis. After hospitalization, hemodialysis was immediately required because of uremia and oliguria. Her renal function did not improve despite corticosteroid therapy. To treat the increasing HCV load, virus removal and eradication by double-filtration plasmapheresis therapy without interferon was performed, since the patient was allergic to interferon therapy. This treatment improved renal function and allowed the withdrawal from hemodialysis. This report presents a case of successful VRAD without interferon therapy in a patient with HCV-related glomerulonephritis and acute kidney injury that required hemodialysis.

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“…ПТ ГК активно применяют для лечения таких заболеваний, как системная красная волчанка (СКВ) [13, 16,21], гломерулонефриты [19,39], РА и системные васкулиты (СВ) [28,45]. В исследование С. Tani (2010) были включе-Казанский медицинский журнал, 2013 г., том 94, №6 ны 30 женщин с СКВ и диффузным пролиферативным гломерулонефритом, получавших ПТ ГК и краткий курс ПТ циклофосфамидом.…”

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Glucocorticoid pulse therapy аnd carbohydrate metabolism in rheumatic diseases

Nurullina

2013

Kazan Med J

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Glucocorticoids are used in clinical practice for more than 50 years and are a great advance in the treatment of systemic inflammatory diseases. High doses of intravenous glucocorticoids (pulse therapy) are effective in conditions requiring rapid immunosuppression and antiinflammatory effect, such as systemic lupus erythematosus, rheumatoid arthritis, glomerulonephritis and systemic vasculitides. The advantage of this method are increased efficacy and lower rate of complications associated with prolonged administration of glucocorticoids. At the same time, glucocorticoid pulse therapy is associated with increased risk of hyperglycemia or even can be a cause of steroid-induced diabetes in patients without known hyperglycemia, as well as worsen glycemia control in patients with diabetes. Increased hepatic gluconeogenesis, inhibition of glucose uptake and metabolism in peripheral tissues and altered both receptor and post-receptor insulin action can lead to an increased serum glucose levels. In patients with inadequate compensatory reserves of pancreas, a clinical picture of diabetus mellitus can develop while treated with glucocorticoids. Blood glucose levels begin to rise 6-12 hours after the infusion of high doses of glucocorticoids. Risk factors for developing glucose intolerance and diabetes include advanced age, obesity, family history of diabetes and high cumulative doses of glucocorticoids. Glucocorticoid-induced diabetes is a common complication of pulse therapy, but exact causes are still not elucidated yet, current literature data on glucocorticoid-induced hyperglycemia are scarce.

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Successful steroid treatment in a patient with membranoproliferative glomerulonephritis associated with hepatitis C virus

Cited by 3 publications

References 15 publications

A Case of Cryoglobulinemic Membranoproliferative Glomerulonephritis Induced by Hepatitis C Virus

A Case of Cryoglobulinemic Membranoproliferative Glomerulonephritis Induced by Hepatitis C Virus

Hepatitis C virus-related glomerulonephritis with acute kidney injury requiring hemodialysis that improved with virus removal and eradication using double-filtration plasmapheresis without interferon

Glucocorticoid pulse therapy аnd carbohydrate metabolism in rheumatic diseases

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