Laurino S, Borrelli S, Catapano F, Mascia S, D'Angio' P, Calabria M, Grimaldi M, Salvio A, Minutolo R, De Nicola L, Conte G
Cattedra di Nefrologia, Seconda Universita' degli Studi, Napoli, Italy.
G Ital Nefrol. 2009 May-Jun;26(3):318-27.
HCV-related membranoproliferative glomerulonephritis is the most common cause of hepatitis C-associated renal disease. Its treatment is still under debate and based on scant experimental evidence. The recommended therapeutic strategy depends on the severity of the kidney disease. The first-line treatment for patients with mild to moderate clinical and histological kidney damage is antiviral therapy with pegylated interferon alpha and ribavirin for 48 weeks combined with symptomatic treatment (diuretics, angiotensin converting enzyme inhibitors and angiotensin receptor blockers). In case of severe renal involvement (nephrotic syndrome, nephritic syndrome and/or progressive renal failure, high activity score of glomerulonephritis on light microscopy), the initial treatment may consist of sequential administration of immunosuppressive therapies (plasmapheresis, corticosteroids and cyclophosphamide) and antiviral agents, although no definitive data are yet available from the literature. B-cell depleting agents such as rituximab may be an alternative to conventional therapy in refractory or intolerant patients. Large randomized and controlled clinical trials are needed to establish guidelines for the treatment of HCV-related cryoglobulinemic glomerulonephritis.
丙型肝炎病毒相关的膜增生性肾小球肾炎是丙型肝炎相关肾脏疾病最常见的病因。其治疗仍存在争议，且基于极少的实验证据。推荐的治疗策略取决于肾脏疾病的严重程度。对于临床和组织学上肾脏轻度至中度损伤的患者，一线治疗是使用聚乙二醇化干扰素α和利巴韦林进行48周的抗病毒治疗，并联合对症治疗（利尿剂、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂）。如果出现严重的肾脏受累（肾病综合征、肾炎综合征和/或进行性肾衰竭，光镜下肾小球肾炎活动评分高），初始治疗可能包括序贯给予免疫抑制疗法（血浆置换、皮质类固醇和环磷酰胺）和抗病毒药物，尽管目前文献中尚无确切数据。对于难治性或不耐受的患者，诸如利妥昔单抗等B细胞清除剂可能是传统治疗的替代方案。需要开展大型随机对照临床试验来确立丙型肝炎病毒相关冷球蛋白血症性肾小球肾炎的治疗指南。
