Chronic hepatitis C virus (HCV) has been associated with several extrahepatic diseases, such as membranoproliferative glomerulonephritis (MPGN). α-Interferon is currently the treatment of choice for this association. When this therapy fails clinicians face a difficult challenge due to the lack of useful information in these particularly difficult patients. We report the case of a severe nephrotic syndrome due to MPGN associated HCV infection, in which a triple association – interferon plus ribavirin and cyclophosphamide – was needed to control the disease.

Keywords:
Membranoproliferative glomerulonephritis, Chronic hepatitis, Hepatitis C virus infection, Alpha-interferon, Ribavirin
1.
Thomas DL: Hepatitis C epidemiology. Curr Top Micobiol Immunol 2000;242:25–41.
2.
Pawlotsky J, Roudot-Thoraval F, Simmonds P, Mello J, Ben Yahia M, Andre C: Extrahepatic immunology manifestations in chronic hepatitis C and hepatitis C serotypes. Ann Intern Med 1995;122:169–173.
3.
Pascual M, Perrin L, Giostra E, Schifferli JA: Hepatitis C virus in patients with cryoglobulinemia type II. J Infect Dis 1990;162:569–570.
4.
Johnson RJ, Willson R, Yamabe H, Couser W, Alpers CE, Wener MH, Davis C, Gretch DR: Renal manifestations of hepatitis C virus infection. Kidney Int 1994;46:1255–1263.
5.
Altraif IH, Abdulla AS, Al Sebayel MI, Said RA, Al Suhaibani, Jones AA: Hepatitis C associated glomerulonephritis. Am J Nephrol 1995;15:407–410.
6.
Usalan C, Erdem Y, Altum B, Nar A, Yasavul U, Turgan C, Caglar S: Rapidly progressive glomerulonephritis associated with hepatitis C virus infection. Clin Nephrol 1998;49:129–131.
7.
Gonzalo A, Navarro J, Barcena R, Quereda C, Ortuño J: IgA nephropathy associated with hepatitis C virus infection. Nephron 1995;69:354.
8.
Johnson RJ, Gretch DR, Yamabe H, Hart J, Bacchi CE, Hartwell P, Couser WG, Corey L, Wener MH, Alpers CE, Willson R: Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. N Engl J Med 1993;328:465–470.
9.
Quigg RJ, Brathwaite M, Gardner DF, Gretch DR, Ruddy S: Successful cyclophosphamide treatment of cryoglobulinemic membranoproliferative glomerulonephritis associated with hepatitis C virus infection. Am J Kidney Dis 1995;25:798–800.
10.
Komatsuda A, Imai H, Wakui H, Hamai K, Ohtani H, Kodama T, Oyama Y, Miura AB, Nakamoto Y: Clinicopathological analysis and therapy in hepatitis C virus-associated nephropathy. Intern Med 1996;35:529–533.
11.
Pham HP, Feray C, Samuel D, Gigou M, Azoulay D, Paradis V, Ducret F, Charpentier B, Debuire B, Lemoine A: Effects of ribavirin on hepatitis C-associated nephrotic syndrome in four liver transplant recipients. Kidney Int 1998;54:1311–1319.
12.
Sarac E, Bastacky S, Johnson JP: Response to high-dose α-interferon after failure of standard therapy in MPGN associated with hepatitis C virus infection. Am J Kidney Dis 1997;30:113–115.
13.
Vial T, Descotes J: Clinical toxicities of the interferons. Drug Safety 1994;10:115–150.
14.
Averbuch SD, Austin HA III, Sherwin SA, Antonovych T, Bunn PA, Longo DL: Acute interstitial nephritis with the nephrotic syndrome following recombinant leukocyte A interferon therapy for mycosis fungoides. N Engl J Med 1984;310:32–35.
15.
Lederer E, Truong L: Unusual glomerular lesion in a patient receiving long-term interferon alpha. Am J Kidney Dis 1992;20:516–518.
16.
Coroneos E, Petrusevska G, Varghese F, Truong LD: Focal segmental glomerulosclerosis with acute renal failure associated with α-interferon therapy. Am J Kidney Dis 1996;28:888–892.
17.
Endo M, Ohi H, Fujita T, Oshawa I, Kanmatsuse K, Yamaguchi Y: Appearance of nephrotic syndrome following interferon-α therapy in a patient with hepatitis B virus and hepatitis C virus coinfection. Am J Nephrol 1998;18:439–443.
18.
Pascual M, Thadhani R, Chung RT, Williams WW, Meehan S, Tolkoff-Rubin N, Colvin R, Cosimi AB: Nephrotic syndrome after liver transplantation in a patient with hepatitis C virus-associated glomerulonephritis. Transplantation 1997;64:1073–1076.
19.
D’Amico G: Renal involvement in hepatitis C infection: Cryoglobulinemic glomerulonephritis (nephrology forum). Kidney Int 1998;54:650–671.
20.
Misiani R, Bellavita P, Baio P, Caldara R, Ferruzzi S, Rossi P, Tengattini F: Successful treatment of HCV-associated cryoglobulinemic glomerulonephritis with a combination of interferon-alfa and ribavirin. Nephrol Dial Transplant 1999;14:1558–1560.
© 2002 S. Karger AG, Basel
2002
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.