Cacoub Patrice
Université Pierre-et-Marie-Curie-Paris-6, CNRS, UMR 7087, 75013 Paris, France.
Presse Med. 2012 Mar;41(3 Pt 1):254-9. doi: 10.1016/j.lpm.2011.11.005. Epub 2011 Dec 20.
A kidney involvement is found in 20 to 56% of patients presenting with a cryoglobulinemic vasculitis, type II IgMk, associated to hepatitis C virus infection (HCV). Patients present with a membrano-proliferative glomerulonephritis. In HCV-associated cases, treatment guidelines are adapted to the severity of the disease. In severe forms, including those with kidney involvement, treatment starts with rituximab then an optimal antiviral combination. In non-HCV cases combination with steroids, immunosuppressants and plasmapheresis showed variable efficacy. Retrospective analysis of rituximab showed a great efficacy in more than 80% patients with an increased risk of severe infections (14.1/100 patient-years), particularly in patients over 70 years, with a renal insufficiency and previously treated with high dose steroids.
在患有与丙型肝炎病毒（HCV）感染相关的II型IgMκ冷球蛋白血症性血管炎的患者中，20%至56%的患者存在肾脏受累情况。患者表现为膜增生性肾小球肾炎。在HCV相关病例中，治疗指南会根据疾病的严重程度进行调整。在严重形式的病例中，包括那些有肾脏受累的患者，治疗首先使用利妥昔单抗，然后是最佳的抗病毒联合治疗。在非HCV病例中，联合使用类固醇、免疫抑制剂和血浆置换显示出不同的疗效。对利妥昔单抗的回顾性分析表明，超过80%的患者疗效显著，但严重感染风险增加（14.1/100患者年），特别是70岁以上、有肾功能不全且先前接受过高剂量类固醇治疗的患者。
