Department of Nephrology, Kyoto University Graduate School of Medicine, Japan.
Intern Med. 2021 Feb 15;60(4):583-589. doi: 10.2169/internalmedicine.5461-20. Epub 2020 Sep 30.
Novel treatments with rituximab or direct-acting antiviral agents (DAAs) were expected to improve the clinical outcomes of hepatitis C virus (HCV)-associated cryoglobulinemia in the last decade. Recently, however, persistent cases of cryoglobulinemia have been reported, and the ideal approach to treating such cases has not been established. We herein report a case of the successful treatment of HCV-associated cryoglobulinemic glomerulonephritis with rituximab, DAAs, occasional plasmapheresis and long-term steroid, with the patient's renal function and proteinuria improving over the long term despite serologically persistent cryoglobulinemia. This case suggests the efficacy of combination treatment with rituximab, DAAs, occasional plasmapheresis and long-term steroid for persistent cryoglobulinemia.
在过去十年中，利妥昔单抗或直接作用抗病毒药物（DAAs）等新型疗法有望改善丙型肝炎病毒（HCV）相关冷球蛋白血症的临床结局。然而，最近仍有持续性冷球蛋白血症的病例报告，且此类病例的理想治疗方法尚未建立。本文报告了一例 HCV 相关冷球蛋白血症性肾小球肾炎患者成功接受利妥昔单抗、DAAs、偶尔行血浆置换和长期使用类固醇治疗的病例，尽管血清学持续存在冷球蛋白血症，但患者的肾功能和蛋白尿长期得到改善。该病例提示利妥昔单抗、DAAs、偶尔行血浆置换和长期使用类固醇联合治疗持续性冷球蛋白血症的疗效。
