Nephrotic syndrome during treatment with interferon.

Abstract

Adverse reactions develop in roughly one third of patients treated with gold, the proportion varying from 5",, to 80O, in several reported series.' Eosinophilia occurs in roughly 5O, of patients and has been directly correlated with the development of gold toxicity.2 Vasomotor reactions to gold are not uncommon, but whether they indicate the development of more serious gold toxicity is unknown. Neurological complications, including peripheral neuropathy, myokymia, and a syndrome like the Guillain-Barre syndrome,3 have received little attention even in major textbooks of rheumatology.4 Encephalopathy has been reported: McAuley et al described a patient who recovered fully one month after treatment with gold was stopped.0The severity of the illness in our patient, with residual neurological deficit nearly five months afterwards, shows the serious side effects that may occur during chrysotherapy. Nephrotic syndrome during treatment with interferonInterferon has activity against multiple myeloma. ' In a trial of lymphoblastoid interferon A (Wellferon) given by ambulatory intravenous infusion for myeloma a patient with renal damage developed a nephrotic syndrome. Case reportA 42 year old white woman presented with an IgGL myeloma in Februarv 1980. Serum urea and creatinine concentrations were normal, but her urine contained Bence Jones protein. She received oral melphalan, but the condition did not improve.She was referred to us in June 1983 suffering from back pain. She was kyphotic. Investigations showed extensive lytic bone disease and heavy infiltration of bone marrow with mveloma cells. Serum urea and creatinine concentrations were normal, and her creatinine clearance was 82 ml/min. The serum contained 45 g IgGI. paraprotein?/l. Urine contained 6 g protein f1 with a trace of Bence Jones protein and a prominent leak of paraprotein. There was severe immune suppression, with a serum IgA concentration of < 0-1 g/l. Intravenous cyclophosphamide produced transient benefit, but the disease progressed and in November she was admitted for a trial of interferon given by continuous intravenous infusion.The figure shows the interferon dosage and urinary protein excretion. The urine volume was consistently about two litres dailv. The maximum urinary protein concentration, 34 days after the start of interferon, was 37 g'l, with non-selective proteinuria including 14 g albumin 11, 11 g paraproteinll, and 2 g lambda light chain/l. The electrophoretic patterns of serum and urinarv protein were almost identical, indicating an almost complete leak. Her glomerular filtration rate was 44 ml/min. Her serum albuimin concentration fell to 17 g!l and she developed bilateral ankle oedema. TIhe serum creatinine concentration remained unchanged. Ultrasonography of the kidneys yielded normal results. There were no autoantibodies. Concentrations of C3 and (A were slightly reduced, possibly owing to loss of protein in the urine. Tests for immune complexes (Clq binding and the platelet aggregation test, yielded negative results.Interferon was...

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

“…Because proteinuria and edema developed after the treatment with IFNa [13], and the histological feature reported minimal-change nephropathy and acute interstitial nephritis [14], we thus consider IFNa to be contraindicative in this case. When we used IFNa twice, proteinuria, edema (nephrotic syndrome), and renal dysfunction appeared.…”

Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis

“…Of note, there are also reports of patients who were treated with IFN and had renal biopsy findings of thrombotic microangiopathy (50) and acute tubular necrosis (51). In addition, reversible IFN-associated nephrotic syndrome in the absence of renal biopsy has been described (52).…”

Bullous Eruption with Circulating Pemphigus-Like Antibodies following Interferon-Alpha Therapy

“…hemolytic anemia (3). cutaneous vasculitis [4], nephrotic syndrome [5] and interstitial nephritis [6]. This is the first instance in which IFN-a is incriminated for a skin bullous disease associated with circulating autoantibodies, although this has been reported with IFN-fk a patient treated with IL-2 and IFN-f> developed a bullous disease consistent with pemphigus vulgaris according to the pres ence of circulating pemphigus-like antibodies [7],…”