Liu Hin-Yee, Cheung Catherine Yuen Shan, Cooper Susan Elizabeth
Dialysis Unit, Fraser Health, Abbotsford, British Columbia, Canada.
BMJ Case Rep. 2018 Apr 18;2018:bcr-2017-222477. doi: 10.1136/bcr-2017-222477.
A 37-year-old man with hepatitis C virus (HCV) genotype 3A developed renal failure. In 2007, the patient received a renal transplant and started receiving tacrolimus (Tac); the transplant subsequently failed. In April 2015, the patient restarted haemodialysis and in May initiated sofosbuvir 400 mg and ribavirin 400 mg daily. Baseline Tac level was 6.6 ng/mL and haemoglobin (Hb) was 10.3 g/dL. The patient then left the country for vacation and Hb was found to be dramatically low at 3.7 g/dL on return on 5 August. Ribavirin was put on hold, while darbepoetin dose was increased. On 23 August, Tac level was found undetectable; hence, dosage was increased. Hb eventually bounced back to >10 g/dL in October and Tac to 7.2 ng/mL; ribavirin was restarted at 200 mg three times weekly. HCV RNA level was undetectable at 3 months and remained undetectable 12 weeks after therapy finished.
一名37岁的丙型肝炎病毒（HCV）基因3A感染者出现了肾衰竭。2007年，该患者接受了肾移植，并开始使用他克莫司（Tac）；随后移植失败。2015年4月，患者重新开始血液透析，并于5月开始每日服用400毫克索磷布韦和400毫克利巴韦林。基线Tac水平为6.6纳克/毫升，血红蛋白（Hb）为10.3克/分升。该患者随后出国度假，8月5日回国时发现Hb大幅降至3.7克/分升。利巴韦林暂停使用，同时增加了促红细胞生成素的剂量。8月23日，发现Tac水平检测不到；因此，增加了剂量。Hb最终在10月回升至>10克/分升，Tac升至7.2纳克/毫升；利巴韦林以每周三次、每次200毫克的剂量重新开始使用。治疗3个月时HCV RNA水平检测不到，治疗结束12周后仍检测不到。
