Progressive Renal Failure and Blindness Due to Retinal Hemorrhage after Interferon Therapy for Hepatitis C Virus-associated Membranoproliferative Glomerulonephritis.

Abstract

Wetreated a 67-year-old Japanese womanwith membranoproliterativ e glomerulonephritis (MPGN)and chronic active hepatitis associated with hepatitis C virus (HCV) infection. Treatment commenced with a daily dose of 6 MUIFN oc-2b for 2 weeks, which was changed to three times weekly thereafter. After 2 weeks, HCVRNAin the serum was undetectable and there was a concomitant reduction in proteinuria. Treatment with IFN a-2b was discontinued because of severe headache and fever. Five weeks after the discontinuation of IFN a-2b, the patient experienced the sudden onset of visual loss due to retinal hemorrhage. Subsequently, proteinuria and renal function progressively deteriorated though HCVRNAwas undetectable. This case exemplifies the need for careful monitoring of renal function and retinal lesions not only in patients receiving IFN but also in those following the discontinua-

Diagnosis, management, and treatment of hepatitis C: An update

“…Treatment of cryoglobulinemia‐associated glomerulonephritis also is challenging. Treatment with interferon may exacerbate the vasculitis,308, 309 and therefore should be restricted to those with overt symptoms, with careful monitoring of renal function to ensure that the kidney disease is not worsened 245. Persons with progressive renal failure generally require treatment with immunosuppressive therapy with cyclophosphamide or rituximab, as well as plasmapheresis and pulsed steroids 310, 311.…”

Chapter 9: Infection-related glomerulonephritis

“…360 Treatment with interferon-α may exacerbate cryoglobulinemic vasculitis. 364, 365 Thus, it is recommended that interferon -α should be started after the acute flare has been controlled with immunosuppressive agents. 366 …”

Treatment of Hepatitis C-Mediated Glomerular Disease

“…No data on SVR were reported. Treatment with IFN-α may exacerbate cryoglobulinemic vasculitis [67,68]. Thus, it is recommended that IFN-α should be started after the acute flare has been controlled with immunosuppressive agents [69].…”