Acute renal failure and nephrotic syndrome with alpha interferon therapy

Dimitrov, Yves; Heibel, Françoise; Marcellin, Luc; Chantrel, F.; Moulin, B.; Hannedouche, T

doi:10.1093/ndt/12.1.200

Cited by 36 publications

(14 citation statements)

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“…In a minority of patients, nephritic syndrome with renal failure has been recorded. Conversely, renal toxicity with acute renal failure due to ATN appears less frequent and it had been previously reported in a few patients [34,35,36,37,38,39]. As listed in Table 2, these reports concerned mostly the treatment of haematological or solid neoplastic disorders, with dosages of interferon frequently higher than in the current case.…”

Section: Discussionmentioning

confidence: 54%

Acute Tubular Necrosis Following Interferon-Based Therapy for Hepatitis C: Case Study with Literature Review

Fabrizi

Aghemo

Fogazzi

et al. 2013

Kidney Blood Press Res

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Background/Aims: Interferon treatment of malignant or viral diseases can be accompanied by various side-effects including nephro-toxicity. Methods: We report on a 68-year-old Caucasian male who received dual therapy with pegylated interferon 2a plus ribavirin for chronic hepatitis C. Results: After three months of antiviral therapy, the patient developed acute kidney failure (serum creatinine up to 6 mg/dL) with mild proteinuria (500 mg daily) and haematuria. Immediate immunosuppressive therapy with high-dose intravenous steroids did not improve kidney function. Kidney biopsy was consistent with acute tubular necrosis without glomerular abnormalities. He started long-term peritoneal dialysis (four regular exchanges) to provide both dialysis adequacy and ascites removal. Kidney function gradually improved over the following months (serum creatinine around 2 mg/dL) and peritoneal dialysis was continued with two exchanges daily. The temporal relationship between the administration of the drug and the occurrence of nephro-toxicity, and the absence of other obvious reasons for acute tubular necrosis support a causative role for pegylated interferon; benefit on kidney disease was noted after withdrawal of antiviral agents. An extensive review of the literature on acute tubular necrosis associated with interferon-based therapy, based on in vitro data and earlier case-reports, has been made. The proposed pathogenic mechanisms are reviewed. Conclusions: Our case emphasizes the importance of monitoring renal function during treatment of chronic hepatitis C with antiviral combination therapy as treatment may precipitate kidney damage at tubular level.

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Section: Discussionmentioning

confidence: 54%

Acute Tubular Necrosis Following Interferon-Based Therapy for Hepatitis C: Case Study with Literature Review

Fabrizi

Aghemo

Fogazzi

et al. 2013

Kidney Blood Press Res

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“…Renal abnormalities, including nephrotic-range proteinuria, have been reported with INF-· therapy [12][13][14][15][16][17][18]. The nephrotic syndrome caused directly by INF-· was likely to be consistent with minimal-change nephropathy [12,15] and was generally resolved by discontinuation of INF-·.…”

Section: Discussionmentioning

confidence: 99%

“…Membranoproliferative GN has been described in a patient treated with INF-· for human immunodeficiency virus infection [16], and in a patient with hairy-cell leukemia in whom the nephrotic syndrome developed after the treatment [13]. Dimitrov et al [18] have recently reported an interesting case of a reversible nephrotic syndrome with acute renal failure during INF-· therapy for HBV reactivation following chemotherapy for a malignant lymphoma. It was speculated that proteinuria had been related to MGN preceding INF-· therapy and had transiently greatly deteriorated during treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Although the etiological role of INF-· in causing severe proteinuria remains obscure, it has been suspected that INF causes disordered immune processes resulting in renal abnormalities in some patients besides nephrotoxicity itself [12,[14][15][16]18]. The disruption in immunoregulation may particularly underlie the pathologic mechanisms associated with INF-· therapy in those patients with chronic liver disease who have had a disregulated autoimmune state and an impaired cellular immune response [1].…”

Section: Discussionmentioning

confidence: 99%

“…Although favorable responses to INF-· in those patients have been reported, the effect of the treatment on GN is unclear in patients showing serum markers of chronic infection with both HBV and HCV. In addition, INF-·-induced renal injury has been documented in some cases [12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Appearance of Nephrotic Syndrome following Interferon-α Therapy in a Patient with Hepatitis B Virus and Hepatitis C Virus Coinfection

et al. 1998

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A 59-year-old woman with hepatitis B surface antigen (HBsAg) and hepatitis C viral (HCV) antibody presented with proteinuria and hematuria. The patient was treated with interferon-alpha (INF-α) because plasma aminotransferase levels had been elevated and a liver biopsy had showed chronic active hepatitis. Her urinary protein excretion decreased as liver function normalized and her serum HCV-RNA was negative during treatment. Eleven weeks after completion of INF-α treatment, she suddenly presented with nephrotic-range proteinuria, although an improvement in the hepatic function was maintained. Renal pathologic findings were consistent with membranous glomerulonephritis (MGN), and HBsAg was detected in the glomeruli but not HCV. After treatment with prednisolone, her 24-hour protein excretion was below 0.7 g/day. To our knowledge this is the first report on hepatitis B virus MGN with nephrotic syndrome following IFN-α therapy for HCV. This suggests that treatment with INF-α might affect the immune processes and may be associated with the pathogenic mechanism in this patient.

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