Broad spectrum of interferon-related nephropathies-glomerulonephritis, systemic lupus erythematosus-like syndrome and thrombotic microangiopathy: A case report and review of literature

Abstract

BACKGROUNDInterferons (IFNs) are characterized by a wide range of biological effects, which justifies their potential therapeutic use in several pathologies, but also elicit a wide array of adverse effects in almost every organ system. Among them, renal involvement is probably one of the most complex to identify.CASE SUMMARYWe describe four cases of kidney damage caused by different IFN formulations: IFN-β-related thrombotic microangiopathy, IFN-β-induced systemic lupus erythematosus, and two cases of membranous nephropathy secondary to pegylated-IFN-α 2B. In each case, we carefully excluded any other possible cause of renal involvement. Once suspected as the casual relationship between drug and kidney damage, IFN treatment was immediately discontinued. In three cases, we observed a complete and persistent remission of clinical and laboratory abnormalities after IFN withdrawal, while the patient who developed thrombotic microangiopathy, despite IFN withdrawal and complement-inhibitor therapy with eculizumab, showed persistent severe renal failure requiring dialysis.CONCLUSIONThis case series highlights the causal relationship between IFN treatment and different types of renal involvement and enables us to delineate several peculiarities of this association.

Exploring the Differences in Molecular Mechanisms and Key Biomarkers Between Membranous Nephropathy and Lupus Nephritis Using Integrated Bioinformatics Analysis

“…However, it has been reported that the decrease of IFN-β expression can indirectly alleviate the damage of TLR3 activator to glomerular endothelial cells ( Hirono et al, 2020 ). In some cases, IFN-β therapy for relapsing-remitting multiple sclerosis (RRMS) has resulted in LN or thrombotic microangiopathy ( Allinovi et al, 2017 ; Gianassi et al, 2019 ). Pegylated -IFN-α 2B treatment of chronic hepatitis C can lead to MN, while no recurrence of kidney disease was observed after stopping the treatment of IFN ( Gianassi et al, 2019 ).…”

“…In some cases, IFN-β therapy for relapsing-remitting multiple sclerosis (RRMS) has resulted in LN or thrombotic microangiopathy ( Allinovi et al, 2017 ; Gianassi et al, 2019 ). Pegylated -IFN-α 2B treatment of chronic hepatitis C can lead to MN, while no recurrence of kidney disease was observed after stopping the treatment of IFN ( Gianassi et al, 2019 ). However, this MN is not idiopathic, and recombinant IFN-α has been reported to have a therapeutic effect on Hepatitis B associated MN ( Lin, 1995 ; Lopes Neto et al, 1998 ).…”

IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection

“…We postulated that these histological findings were compatible with GN, secondary to SARS-CoV-2 itself or to another superimposed infection, yet no other infection was documented in this patient. The possibility that the causative agent was prior treatment with IFN was also initially raised, in which context, this drug has been associated with a broad spectrum of glomerulopathies [ 19 , 20 ]. Nevertheless, the IgA-DIAGN emerged approximately seven weeks after IFN treatment, and the histological findings in this patient are unlikely to be related to interferon.…”

Immunologic markers, vasculitis-associated autoantibodies, and complement levels in patients with COVID-19

“…There is a broad spectrum of interferon-related complications including glomerulonephritis, systemic lupus erythematosus (SLE)-like syndrome, and thrombotic microangiopathy that may be associated with hypocomplementemia. [ 30 31 ] Drug-induced lupus erythematosus is a syndrome with clinical and serological features similar to SLE that is temporally related to continuous drug exposure and resolves after discontinuation of the drug. More than 90 drugs, including interferons, are involved in causing the disease.…”