Minimal Change Disease in a Patient Receiving IFN-α Therapy for Chronic Hepatitis C Virus Infection

Abstract

Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic syndromes. The principal types of renal disorders associated with chronic HCV infection are cryoglobulinemia or noncryoglobulinemic membranoproliferative glomerulonephritis (MPGN). Interferon-alpha (IFN-alpha) may precipitate or exacerbate the occurrence of MPGN. Our patient was a 32-year-old man who tested positive for HCV in July 1997. The patient was treated with IFN-alpha in another medical center for 6 months because his liver biopsy showed chronic active hepatitis. In December 1998, he applied to our clinic for a follow-up examination. The level of aspartate aminotransferase (AST) was 44 U/L, and that of alanine aminotransferase (ALT) was 69 U/L. HCV RNA was positive in serum, and chronic HCV infection was detected by liver biopsy. IFN-alpha therapy (5 million U/day) was administered for 6 months longer. In May 1999, the patient came to our polyclinic with edema of the feet and legs. We detected proteinuria, serum cholesterol of 269 mg/dl, AST of 50 U/L, ALT of 41 U/L, serum total protein of 3.4 g/dl, serum albumin of 1.2 g/dl, positive cryoglobulin, and urine protein of 9.84 g/day. Cryoglobulinemic MPGN was suspected and kidney biopsy was performed, resulting in a diagnosis of minimal change disease (MCD).

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

“…IFN-α therapy has been implicated in various renal diseases such as renal thrombotic microangiopathy (in patients with chronic leukemia) [12], interstitial nephritis [13], and glomerular diseases including podocytopathies (focal segmental glomerulosclerosis and minimal change disease) or immune complex glomerulonephritis (membranous nephropathy, membrano-proliferative glomerulonephritis, IgA nephropathy), as shown in several case reports published over the last 20 years [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. In addition, case series have been published [31].…”

“…Additional papers provided evidence of exacerbation of pre-existing glomerular disease during IFN [32,33]. The usual presentation of glomerular disease associated with IFN is isolated proteinuria, and nephrotic syndrome [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. In a minority of patients, nephritic syndrome with renal failure has been recorded.…”

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

“…Our two patients developed nephrotic syndrome with a histological pattern of membranous nephropathy while on Peg-IFN-α therapy. Cases of nephritic or nephrotic syndrome have been reported during treatment with IFN associated with different underling nephropathies, such as focal segmental glomerulosclerosis[31-34], minimal change disease[35,36], IgA nephropathy[37], and membranoproliferative glomerulonephritis[38,39]. Among these, MN is an uncommon but important and previously described pattern[40,41].…”

Drug-induced Kidney Disease – Pathology and Current Concepts

“…10,11 The pathogenic role of T-lymphocytes and interleukins were described in these and a more recent study. 12 Several other medications have been implicated in MCD, including COX-2 inhibitors, 13 the interferons 14,15 and pamidronate 16 (a bisphosphonate). At the functional (physiologic) level, the nephrotoxicity of NSAIDS and COX-2 inhibitors can be explained by their inhibition of renal prostaglandin synthesis, leading to an imbalance of vasodilation and vasoconstrictive forces in favour of the latter.…”