Division of Nephrology, Maggiore Policlinico Hospital, IRCCS Foundation, Milano, Italy.
Am J Kidney Dis. 2013 Apr;61(4):623-37. doi: 10.1053/j.ajkd.2012.08.040. Epub 2012 Oct 25.
Hepatitis C virus (HCV) may instigate mixed cryoglobulinemia; the most significant accompanying kidney lesion is type I membranoproliferative glomerulonephritis, usually occurring in the context of type II mixed cryoglobulinemia. Additionally, recent data support a link between HCV infection and proteinuria in population-based studies, raising the possibility that kidney diseases associated with HCV may be more common than previously thought. A number of strategies have been used to treat HCV-related glomerulonephritis, including antiviral agents, immunosuppressive therapies such as corticosteroids and cytotoxic agents, and plasma exchange. Limited but encouraging data about the utility of antiviral treatment in the setting of HCV-associated glomerulonephritis exist, with one pooled analysis noting a sustained viral response of 42%, albeit with significant heterogeneity. Immunosuppressive therapy may be most useful for cryoglobulinemic kidney disease, with individualized approaches considered for the treatment of HCV-associated cryoglobulinemic glomerulonephritis based on the level of proteinuria and kidney failure. Of note, rituximab, a chimeric monoclonal antibody that blocks CD20 receptors on B cells, has been reported to be effective for the treatment of mixed cryoglobulinemia symptoms, including glomerulonephritis.
丙型肝炎病毒（HCV）可能引发混合性冷球蛋白血症；最常见的伴随肾脏病变是 1 型膜增生性肾小球肾炎，通常发生在 2 型混合性冷球蛋白血症的背景下。此外，最近的数据支持 HCV 感染与人群中蛋白尿之间存在关联，这增加了与 HCV 相关的肾脏疾病可能比以前认为的更为常见的可能性。已经使用了多种策略来治疗 HCV 相关的肾小球肾炎，包括抗病毒药物、免疫抑制疗法，如皮质类固醇和细胞毒性药物，以及血浆置换。关于在 HCV 相关性肾小球肾炎中使用抗病毒治疗的有限但令人鼓舞的数据存在，一项汇总分析注意到持续病毒应答率为 42%，尽管存在显著的异质性。免疫抑制疗法可能对冷球蛋白血症性肾脏疾病最有用，根据蛋白尿和肾衰竭的程度，考虑采用个体化方法治疗 HCV 相关性冷球蛋白血症性肾小球肾炎。值得注意的是，利妥昔单抗是一种嵌合单克隆抗体，可阻断 B 细胞上的 CD20 受体，已被报道对治疗混合性冷球蛋白血症症状，包括肾小球肾炎有效。
