Sandhu Gagangeet, Stokes M Barry, Meisels Ira
Department of Medicine, St. Luke's-Roosevelt Hospital Center , Columbia University College of Physicians and Surgeons , New York, NY USA.
Department of Pathology , Columbia University College of Physicians and Surgeons , New York, NY , USA.
NDT Plus. 2010 Aug;3(4):363-5. doi: 10.1093/ndtplus/sfq078. Epub 2010 May 5.
Treatment with antiviral and/or immunosuppressive therapy is considered the standard care in patients with hepatitis C virus (HCV)-associated membranoproliferative glomerulonephritis (MPGN). However, even with an adequate therapy, a favourable response is not always guaranteed. In patients with HCV-associated MPGN, a delayed spontaneous remission of nephrotic syndrome is rare. We present here one such case. Our patient refused antiviral (and immunosuppressive) therapy throughout the course of his illness and was thus managed symptomatically. More than 8 months after presentation, an unexpected gradual resolution of his nephrotic syndrome was noted. The urine protein/creatinine ratio decreased from ~16 000 mg/g of creatinine on presentation to 500 mg/g of creatinine in the 12th month. This was however not accompanied by resolution of HCV or cryoglobulinaemic activity. Our case demonstrates the possibility of a delayed spontaneous remission occurring in this disease. This must be considered when weighing treatment options in such patients.
对于丙型肝炎病毒（HCV）相关的膜增生性肾小球肾炎（MPGN）患者，抗病毒和/或免疫抑制治疗被视为标准治疗方法。然而，即使采用充分的治疗，也并非总能保证获得良好的反应。在HCV相关的MPGN患者中，肾病综合征延迟自发缓解的情况很少见。我们在此介绍这样一个病例。我们的患者在整个病程中拒绝抗病毒（和免疫抑制）治疗，因此接受了对症治疗。就诊8个多月后，发现他的肾病综合征意外地逐渐缓解。尿蛋白/肌酐比值从就诊时的约16000mg/g肌酐降至第12个月时的500mg/g肌酐。然而，这并未伴随着HCV或冷球蛋白血症活性的消退。我们的病例表明了这种疾病出现延迟自发缓解的可能性。在权衡此类患者的治疗选择时，必须考虑到这一点。
