Recurrent Mixed Cryoglobulinemia Despite Sustained Virologic Response to Treatment: A Case Report

Chowdhury, Renuka; Tsen, Adrianne

doi:10.1053/j.ajkd.2017.01.041

Cited by 14 publications

(12 citation statements)

References 15 publications

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“…Reports of HCV cryoglobulinemic glomerulonephritis despite SVR after DAA therapy are rare. Previous studies have reported the recurrence of MC after DAA therapy in small numbers of patients [16]. There are recent reports of treating MC and HCV with DAA, with clinical response achieved in about 38%; immunological response was slightly lower (29%).…”

Section: Discussionmentioning

confidence: 93%

See 1 more Smart Citation

Incidence and Characteristics of de novo Renal Cryoglobulinemia After Direct-Acting Antivirals Treatment in an Egyptian Hepatitis C Cohort

Nokeety

Abdelaziz

Samir

et al. 2018

Nephron

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Introduction: The side effects profile of the new direct-acting antivirals for the treatment of hepatitis C virus (HCV) is not fully elucidated. Objective: In this cross-sectional study, we aim to describe the incidence and characteristics of a novel observation of de novo renal cryoglobulinemic glomerulonephritis after successful treatment with DAA. Methodology: A total of 12,985 Hepatitis C Patients (genotype IV) received the new DAA. After successful treatment, patients with deranged renal functions or proteinuria were referred to the nephrology department for assessment. The clinical manifestations ranged from lower limb edema to the development of purpura skin lesions. Cryoglobulins were tested in the serum using the PCR detection. Results: Fifty patients had detectable de novo cryoglobulins in the serum. The most common type in renal biopsies was membranoproliferative glomerulonephritis (52%) and chronic kidney disease (CKD) developed in 46% of cases. Conclusion: De novo cryoglobulinemic glomerulonephritis and progression to CKD may rarely complicate successful treatment of HCV using direct-acting antivirals.

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Section: Discussionmentioning

confidence: 93%

“…Another possible explanation for the occurrence of cryoglobulinemia following SVR is the persistence of few copies of HCV-RNA in liver cell, macrophages, or lymphocytes. This leads to the persistent stimulation of the immune system and formation of cryoglobulins [16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Characteristics of de novo Renal Cryoglobulinemia After Direct-Acting Antivirals Treatment in an Egyptian Hepatitis C Cohort

Nokeety

Abdelaziz

Samir

et al. 2018

Nephron

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“…In type II cryoglobulinemia, monoclonal IgM antibodies aberrantly complex with poly- standard therapy (40%) [8,9]. Another study showed that over 90% of patients that used oral direct acting antiviral agents achieved SVR over 12 weeks of treatment [10]. Data are lacking in cases of active cryoglobulinemia and undetectable HCV viral load.…”

Section: Discussionmentioning

confidence: 99%

A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

Christopher¹,

Victor²,

Leigh³

et al. 2020

J Clin Nephrol Ren Care

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Cryoglobulinemic vasculitis is a complex and destructive disease process that affects multiple organ systems. The pathophysiology includes formation of immune complex deposits that create an inflammatory response in various organs, yielding distinct presentations such as purpura, arthralgias, neuropathy, fever, and pulmonary vasculitis. Over 30% of cryoglobulinemic vasculitis cases present with glomerulonephritis, which carries a worse prognosis. The majority of mixed cryoglobulinemia cases are due to active infection with hepatitis C virus (HCV). Treatment of cryoglobulinemic vasculitis involves treatment of underlaying HCV, as well as high doses of immunosuppressive agents such as steroids and rituximab, often for multiple months, but with resolution of symptoms. It is rare for a patient who achieved sustained virologic response after HCV treatment to develop mixed cryoglobulinemia. Here, we present a rare case of cryoglobulinemic glomerulonephritis in a patient who was successfully treated for HCV infection.

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“…Another explanation as to why achievement of SVR12 may not improve renal disease progression is that patients may have intrinsic renal disease prior to treatment, such as MPGN, and these patients will have CKD progression despite achieving SVR12; this has been previously described in the literature in case reports[ 24 ]. However, other reports have suggested that DAA therapy can result in successful treatment of HCV-associated MPGN with improvement in creatinine and proteinuria[ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of sustained virologic response on chronic kidney disease progression in hepatitis C

Aby

Dong

Kawamoto

et al. 2017

WJH

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AIMTo determine how sustained virological response at 12 wk (SVR12) with direct acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection affects chronic kidney disease (CKD) progression.METHODSA retrospective analysis was performed in patients aged ≥ 18 years treated for HCV with DAAs at the VA Greater Los Angeles Healthcare System from 2014-2016. The treatment group was compared to patients with HCV from 2011-2013 who did not undergo HCV treatment, prior to the introduction of DAAs; the control group was matched to the study group in terms of age, gender, and ethnicity. Analysis of variance and co-variance was performed to compare means between SVR12 subgroups adjusting for co-variates.RESULTSFive hundred and twenty-three patients were evaluated. When comparing the rate of change in estimated glomerular filtration rate (eGFR) one-year after HCV treatment to one-year before treatment, patients who achieved SVR12 had a decline in GFR of 3.1 mL/min ± 0.75 mL/min per 1.73 m2 compared to a decline in eGFR of 11.0 mL/min ± 2.81 mL/min per 1.73 m2 in patients who did not achieve SVR12 (P = 0.002). There were no significant clinical differences between patients who achieved SVR12 compared to those who did not in terms of cirrhosis, treatment course, treatment experience, CKD stage prior to treatment, diuretic use or other co-morbidities. The decline in eGFR in those with untreated HCV over 2 years was 2.8 mL/min ± 1.0 mL/min per 1.73 m2, which was not significantly different from the eGFR decline noted in HCV-treated patients who achieved SVR12 (P = 0.43).CONCLUSIONPatients who achieve SVR12 have a lesser decline in renal function, but viral eradication in itself may not be associated improvement in renal disease progression.

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Recurrent Mixed Cryoglobulinemia Despite Sustained Virologic Response to Treatment: A Case Report

Cited by 14 publications

References 15 publications

Incidence and Characteristics of de novo Renal Cryoglobulinemia After Direct-Acting Antivirals Treatment in an Egyptian Hepatitis C Cohort

Incidence and Characteristics of de novo Renal Cryoglobulinemia After Direct-Acting Antivirals Treatment in an Egyptian Hepatitis C Cohort

A Case of Cryoglobulinemia after Successful Hepatitis C Virus Treatment

Impact of sustained virologic response on chronic kidney disease progression in hepatitis C

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