Interferon-alpha in combination with ribavirin as initial treatment for hepatitis C virus-associated cryoglobulinemic membranoproliferative glomerulonephritis

Mixed cryoglobulinemia (MC) and glomerulonephritis are the most important e xtrahepatic manifestations of chronic hepatitis C virus (HCV) Infection. In HCV-infected patients with MC, renal involvement worsens the overall progn osis because of a high Incidence of Infection or cardiovascular disease. Th e relationship between MC and HCV Infection has prompted the use of antivir al therapy. Two patients with chronic HCV Infection, type-II MC and membran o proliferative glomerulonephritis (MPGN), presenting as nephrotic syndrome were treated with Interferon (IFN)-alpha (3 MU 3 times per week) and ribav irin (15 mg/kg daily) for 6 months. Laboratory tests included measurement o f anti-HCV antibodies, HCV RNA, and HCV genotyping, and characterization of circulating cryoglobulins. A pretreatment renal biopsy was performed, and the histopathologic lesions were scored according to the index of disease a ctivity. Viremia and cryoglobulinemia were suppressed In both patients. How ever, a complete remission of proteinuria was observed in I patient only. T he evaluation of the renal biopsy specimens revealed a mild MPGN (activity score: 5/24) in the patient with remission of proteinuria and a severe MPGN (activity score: 15/24) In the patient who maintained a nephrotic-range pr oteinuria. Although a fully satisfactory treatment is not yet available, we feel that a reasonable therapeutic strategy for HCV-infected patients with MC nephritis could be as follows: (1) antiviral treatment alone for patien ts with a low-grade kidney involvement, and (2) a short-term course of ster oids and cytotoxic drugs followed by antiviral therapy for acute exacerbati ons and/or rapidly progressive GN. (C) 2001 by the National Kidney Foundati on, Inc.