Hepatitis C virus–related cryoglobulinemic glomerulonephritis: Long-term remission after antiviral therapy

Hepatitis C virus–related cryoglobulinemic glomerulonephritis: Long-term remission after antiviral therapy.BackgroundRenal involvement in patients with hepatitis C virus (HCV) infection commonly manifests as cryoglobulinemic glomerulonephritis (CGN). The combination of interferon-alpha (IFN-α) and ribavirin, which is currently considered the standard antiviral therapy in chronic hepatitis C, could be difficult to carry out in cryoglobulinemic patients who are frequently anemic, even in the absence of renal failure. Clinical and histologic long-term results of this therapeutic regimen have not been so far reported in patients with CGN.MethodsThree patients with HCV-related CGN and slightly impaired kidney function were treated with IFN-α and ribavirin for 12 months, and subsequently were followed up for 24 to 36 months. Two of these patients who were anemic were pretreated with erythropoietin (EPO). In each patient renal biopsy was performed before starting therapy and repeated 14 to 26 months after the end of treatment.ResultsIn all three patients, antiviral therapy induced sustained virologic response, which was followed by clear improvement in clinical, biochemical, immunologic, and histologic features. Clinical and biochemical improvement steadily progressed in all three patients, achieving normal or nearly normal results at the end of follow-up. In contrast, some immunologic features, such as serum levels of C4 and rheumatoid factor activity, did not normalize in two and three patients, respectively. Posttreatment renal biopsies showed mildly active histologic lesions.ConclusionAntiviral therapy with IFN-α and ribavirin may be considerably beneficial in patients with HCV-related CGN who obtain sustained virologic response