Hepatitis C Virus-related Heat-insoluble Cryoglobulinemia and Thrombotic Microangiopathy

Wu, Hao; Zou, Haifeng; Xü, Ying; Zhang, Li; Du, Yujun; Yu, Jinyu; Lu, Rongzhu; Li, Xiang

doi:10.1097/maj.0b013e318293cdee

Cited by 11 publications

(11 citation statements)

References 15 publications

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“…To the best of our knowledge, type I monoclonal CG accompanying TMA has never been reported. Only two reports exist concerning mixed CG, in which CG and TMA occurred concurrently [13,14]. In both cases, patients had massive proteinuria and renal biopsies revealed typical MPGN.…”

Section: Discussionmentioning

confidence: 99%

A case of acute renal failure of multiple myeloma due to monoclonal type I cryoglobulinemia with thrombotic microangiopathy

et al. 2014

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The term cryoglobulinemia (CG) is used to refer to vasculitis due to so-called mixed cryoglobulins containing immune complexes. Although most cases of monoclonal CG, called type I CG, are asymptomatic, purpura, skin ulcers, and renal failure develop in some cases. Hematological disorders are the underlying diseases in most cases, on which the therapeutic strategies available and the prognosis of patients depends. We here report a case of a 47-year-old man who had pain in both his ankles, with palpable purpura and epistaxis, and presented with acute renal failure. Monoclonal immunoglobulin (Ig) G-j protein was detected and cryoglobulin was also positive. Renal biopsy revealed emboli with a fibrillar structure in the glomeruli and renal tubule lumina. The complication of thrombotic microangiopathy (TMA) occurred during the course. Therefore, plasma exchange and hemodialysis were added to methylprednisolone pulse therapy. The treatment was successful, dissipating the purpura. However, the purpura relapsed and renal dysfunction progressed when the administration of oral steroids was tapered. Bone marrow biopsy was performed again, which indicated an increase in abnormal plasma cells. The patient was finally diagnosed as multiple myeloma. Then, bortezomib-dexamethasone therapy was initiated. This is the first case of type I CG with monoclonal IgG complicated by TMA during the course; it provides insight into the pathogenesis of renal dysfunction associated with type I CG.

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Section: Discussionmentioning

confidence: 99%

A case of acute renal failure of multiple myeloma due to monoclonal type I cryoglobulinemia with thrombotic microangiopathy

et al. 2014

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“…Occasionally, cryoglobulinemic thrombotic microangiopathy can occur. 45 Not surprisingly, in the setting of chronic liver disease, IgA nephropathy has also been reported in HCV infection. Using the VA Database, El-Serag and colleagues 46 performed a case-control study that enrolled all cases of HCV-infected patients hospitalized during 1990s and randomly chosen control individuals without HCV.…”

Section: Hepatitis C Virus-associated Glomerular Diseasesmentioning

confidence: 97%

Glomerular Diseases Associated With Hepatitis B and C

Gupta

Quigg

2015

Advances in Chronic Kidney Disease

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“…Five case reports discuss high-dose steroids used in the absence of other immunosuppressive therapies and concomitantly with antiviral therapy ( Table 4 ). 81 – 85 Four studies reported on patients with MPGN and/or vasculitis; three of four patients achieved a favorable clinical response and one of two achieved SVR. 81 – 84 Overall, SVR was achieved in three of four patients for which it was reported.…”

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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Hepatitis C Virus-related Heat-insoluble Cryoglobulinemia and Thrombotic Microangiopathy

Cited by 11 publications

References 15 publications

A case of acute renal failure of multiple myeloma due to monoclonal type I cryoglobulinemia with thrombotic microangiopathy

A case of acute renal failure of multiple myeloma due to monoclonal type I cryoglobulinemia with thrombotic microangiopathy

Glomerular Diseases Associated With Hepatitis B and C

Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

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