REVIEW - Hepatitis C virus-related cryoglobulinemia and glomerulonephritis: pathogenesis and therapeutic strategies

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Ann Ital Med Int. 2005 Apr-Jun;20(2):71-80.

Hepatitis C virus-related cryoglobulinemia and glomerulonephritis:

pathogenesis and therapeutic strategies.

Garini G, Allegri L, Vaglio A, Buzio C.

Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione,

Universita degli Studi di Parma. garini@...

Mixed cryoglobulinemia (MC) and glomerulonephritis are the most important

extrahepatic manifestations of chronic hepatitis C virus (HCV) infection. MC

is a non-neoplastic B cell lymphoproliferative process induced by HCV in an

antigen-driven mechanism. The clinical expression of cryoglobulinemia varies

from an indolent course to the development of systemic vasculitis.

Glomerulonephritis is predominantly associated with MC, and almost always

takes the form of membranoproliferative glomerulonephritis. The renal

manifestations may range from isolated proteinuria to overt nephritic or

nephrotic syndrome with variable progression towards chronic renal

insufficiency. The treatment of these virus-related diseases must be

individualized on the basis of the severity of clinical symptoms. Antiviral

therapy with interferon alpha and ribavirin (the currently recommended

treatment of HCV infection) may be successful in patients with

mild-to-moderate disease, but sustained responses are uncommon. In case of

severe and rapidly progressive disease, although it is capable of

suppressing viremia and cryoglobulinemia, antiviral therapy is not fully

effective in controlling the inflammatory and self-perpetuating reaction

consequent to the deposition of cryoglobulins in the glomeruli and vessel

walls. In such cases, a short course of steroids and cytotoxic drugs (with

or without plasmapheresis) may be needed to improve the vascular

manifestations and decrease the production of cryoglobulins. Once the acute

disease flare has been controlled, antiviral therapy may be administered to

eradicate HCV, the causative agent of the cryoglobulinemic syndrome. In

patients in whom antiviral therapy is ineffective, contraindicated or not

tolerated, rituximab, a monoclonal anti-CD20 antibody, may be an alternative

to standard immunosuppression.

PMID: 16052839

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

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