Therapy with interferon-alpha plus ribavirin for membranoproliferative glomerulonephritis induced by hepatitis C virus

Abstract

We describe a treatment made with interferon-alpha (IFN-alpha) plus ribavirin of two patients with membranoproliferative glomerulonephritis (MPGN) induced by hepatitis C virus (HCV): case # 1 was a 22-yr-old woman with leg and facial edema, hypertension and proteinuria, whose liver biopsy revealed chronic active hepatitis; and case # 2 was a 42-yr-old man with anasarca, hypertension and proteinuria, whose liver biopsy indicated cirrhosis. Both had anti-HCV, HCV-RNA and cryoglobulins. IFN-alpha (3 million units (MU), 3 times/week) and ribavirin (1 g/day) were administered for 12 months. The drugs were well tolerated by both patients. Serum alanine aminotransferase (ALT) levels normalized and HCV-RNA became negative. Cryoglobulins disappeared and an improvement in renal disease was seen after 6 months of therapy. However, after 9 months, case # 2 presented ALT elevation, and proteinuria was detected. Two years after the end of therapy, both patients were negative in repeated HCV-RNA and cryoglobulin tests. Case # 1 was asymptomatic, with normal liver and renal tests, and case # 2 had normal blood pressure, with mild edema of the ankles. Based on the evolution of these two cases, the association of IFN-alpha and ribavirin may be a therapeutic option for patients with MPGN related to HCV.

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

“…Two patients maintained normal renal function [10], but only one of two patients had a complete remission of proteinuria [11]. In the study of Alric et al [9], anti-viral treatment improved HCV-associated cryglobunemic MPGN.…”

“…Clinically, a patient with nephrotic syndrome following cryoglobulinemic MPGN induced by HCV with CAH, was reported to be successfully treated with low-dose corticosteroid (PSL). Various therapies have been proposed for MPGN associated with HCV: hormonal treatment (IFNa [2,[4][5][6]), immunosuppressive drugs (corticosteroids [4,8,9], cyclophosphamide [7]), antiviral drug (ribavirin [9][10][11]) and plasma exchange [9,12]. In particular, the use of corticosteroids and cyclophosphamide remain controversial.…”

“…IFNa was used in combination with ribavirin as the treatment for HCV associated cryoglobulinemic MPGN [9][10][11]. Two patients maintained normal renal function [10], but only one of two patients had a complete remission of proteinuria [11].…”

Hépatites virales chroniques chez les patients insuffisants rénaux

“…Certains auteurs ont montré que 15 % des patients infectés par le VHC avec une cryoglobulinémie développent une gloméru-lonéphrite, particulièrement la glomérulonéphrite membranoproliférative [25,26]. L'étude de la prévalence de l'infection virale C en cas de glomérulonéphrite membranoproliférative trouve une fréquence de 13 % [27]. Ces lésions glomérulaires sont caractérisées par l'évolution rapide vers l'insuffisance rénale.…”

“…Elles justifient une prise en charge thérapeutique précoce par les antiviraux les plus efficaces pour éviter une détérioration irréversible de la fonction rénale [28]. Les résultats des études immunologiques et virologiques suggèrent que l'atteinte rénale est due aux dépôts de complexe immuns contenant le VHC au niveau des glomérules [23,27,[29][30][31].…”