HEPATITIS-C VIRUS-ASSOCIATED GLOMERULONEPHRITIS - EFFECT OF ALPHA-INTERFERON THERAPY

Hepatitis C virus (HCV) infection may present as a primary glomerular disease. We report 34 adult patients who presented with proteinuria an d had circulating anti-HCV antibodies. Primary risk factors included a history of intravenous drug abuse (56%) or blood transfusion (18%). P atients presented with nephrotic syndrome (71%) or with non-nephrotic proteinuria (29%) and had membranoproliferative or acute proliferative glomerulonephritis on renal biopsy. Signs of clinical liver disease w ere infrequent (18%), though elevated liver function tests were common (66%) and liver biopsy in 16 of 18 patients showed chronic active hep atitis. Cryoglobulinemia was frequent (59%), but only 44% had extraren al manifestations. In 100% of cases tested, HCV RNA could be found in the serum or cryoprecipitates. Fourteen patients received interferon a lpha for 6 to 12 months with a significant reduction in proteinuria bu t no improvement in renal function. A good clinical response correlate d with disappearance of HCV RNA from the serum during treatment; howev er, relapse of viremia and renal disease was common after completing t herapy. Evidence for HCV infection should be sought in all patients wi th primary glomerular disease. The optimal treatment strategy, however , remains to be defined.