1/61. role of interferon-alpha in the treatment of primary glomerulonephritis.interferon-alpha (IFN-alpha) is a naturally occurring cytokine. It was the first cytokine used with clinical benefit in the treatment of viral hepatitis and malignancies. patients with viral hepatitis B or C may have complications with glomerulonephritis (GN). Improvement in proteinuria with or without clearing of viral markers after IFN-alpha therapy has been reported. This encouraged us to offer IFN-alpha therapy to four patients with GN. These patients refused treatment with steroids and/or cyclophosphamide because of concerns about side effects. One patient with membranous GN and two patients with mesangial GN (MesGN) had a remission of nephrotic syndrome. In one patient with type II diabetes and MesGN, renal insufficiency and proteinuria did not subside; however, renal function remained stable. The mechanism of action of IFN-alpha is discussed, with its possible role in the treatment of primary GN.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
2/61. Complete remission of cryoglobulinemic glomerulonephritis (HCV-positive) after high dose interferon therapy.We report the case of a 64-year old woman with hepatitis c virus infection, mixed cryoglobulinemia type II (IgG IgM kappa) and cryoglobulinemic glomerulonephritis. The patient was treated with the standard dose of recombinant interferon alpha-2b (3 million units 3 times a week) for one year, resulting in complete clinical remission and undetectable levels of serum hepatitis c virus rna. AST and ALT normalized and proteinuria decreased from 2.78 to 0.98 g/day. However, a relapse occurred when therapy was stopped. Additional therapy with interferon-alpha (5 million units 3 times a week for 9 months) resulted again in quick and prolonged remission. The clinical course of our patient showed sustained clinical and virologic response after high-dose interferon-alpha treatment confirming the usefulness of interferon alpha in treatment of patients with cryoglobulinemic glomerulonephritis. Our observation is in agreement with others, suggesting that recommended standard dosage and duration of initial treatment with interferon alpha should be re-evaluated. Although our patient had sustained virologic and clinical response after interferon alpha monotherapy, recent studies clearly support combination therapy of interferon alpha and ribavirin for treatment of chronic HCV infections.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
3/61. Transformation of hepatitis b virus-related membranous glomerulonephritis to crescentic form.We report a case of hepatitis b virus-(HBV) related membranous glomerulonephritis which progressed to crescentic transformation after withdrawal of immunosuppressive treatment. Immunosuppressive therapy probably enhanced HBV replication, and its withdrawal led to a return of immune competence resulting in progression of the glomerulonephritis. Prior screening of all patients for hepatitis B surface antigen, before using immunosuppressive therapy may prevent this complication. The usage of immunosuppressive therapy as a first-line choice in HBV-related glomerulonephritis may result in harmful complications.- - - - - - - - - - ranking = 3keywords = hepatitis (Clic here for more details about this article) |
4/61. liver transplantation eliminates insulin needs of a diabetic patient.organ transplantation and subsequent therapeutic agents may induce or worsen preexisting diabetes mellitus. We report the case of a diabetic patient whose insulin needs disappeared after liver transplantation. Non insulin-dependent diabetes mellitus was diagnosed when she was 47, and was treated by hypoglycemic drugs and then insulin. Chronic post-hepatitis c cirrhosis was diagnosed at the age of 55 and required liver transplantation 2 years later. During the postoperative course, the insulin doses required to maintain normal glucose levels progressively decreased, and insulin became completely unnecessary by the 29(th) postoperative day. After insulin was stopped, glucose levels remained within normal ranges for the 5-year-long follow-up, despite the worsening of a preexisting diabetic nephropathy and the occurrence of a diabetic retinopathy. This case highlights the fact that liver transplantation may eliminate insulin needs in a diabetic patient but also shows that degenerative complications may occur despite apparent remission of diabetes.- - - - - - - - - - ranking = 0.5keywords = hepatitis (Clic here for more details about this article) |
5/61. Varicella infection in a renal transplant recipient associated with abdominal pain, hepatitis, and glomerulonephritis.A 36-year-old renal transplant patient developed 9 years after a successful transplantation a fatal secondary varicella infection. The disseminated varicella infection was associated with hepatitis with liver necrosis, disseminated intravascular coagulation and fibrinolysis and glomerulonephritis. To our knowledge this is the first description of glomerulonephritis associated with varicella infection in a renal transplanted patient. The autopsy showed morphologically a mesangial glomerulonephritis with minor proliferative activity and extensive deposits by electronmicroscopy, mainly in the mesangium. The ongoing immunosuppression may have modified the mesangial cell response to the deposition of immune complexes.- - - - - - - - - - ranking = 2.5keywords = hepatitis (Clic here for more details about this article) |
6/61. glomerulonephritis after recombinant hepatitis B vaccine.Renal complications after vaccination with hepatitis B recombinant vaccine are rare; very few cases are reported without a histopathologic definition. We describe a case of glomerulonephritis in a 12-year-old girl, beginning after the inoculation of hepatitis B vaccine. The immunohistochemical examination of her renal biopsy, with the use of monoclonal antibodies, shows the presence of hepatitis B surface antigen in renal tissue. After 2 years chronic glomerulonephritis persisted and was treated with angiotensin-converting enzyme inhibitors. After 3 years of follow-up, the renal disease was in remission, and treatment was stopped.- - - - - - - - - - ranking = 3.5keywords = hepatitis (Clic here for more details about this article) |
7/61. Acute glomerulonephritis complicating australia antigen-negative viral hepatitis.A case of acute glomerulonephritis complicating australia antigen-negative hepatitis in a 17-year-old man is described. The literature relating the onset of glomerulonephritis to virus infection is general, and to that of hepatitis in particular, is reviewed.- - - - - - - - - - ranking = 3keywords = hepatitis (Clic here for more details about this article) |
8/61. glomerulonephritis with microtubular deposits associated with cryoglobulinemia and chronic active hepatitis.A 65-year-old-woman presented with edema, ascites, proteinuria and abnormal liver function tests. A small amount of mixed cryoglobulin was detected in her serum. Liver biopsy revealed mild chronic active hepatitis, but tests for hepatotropic viral infection were negative. Electron microscopy of the renal biopsy revealed glomerular electron-dense deposits that contained numerous tubular structures. Renal amyloidosis and light chain deposition disease were ruled out by appropriate histological techniques. The ultrastructural findings of renal biopsy suggested either cryoglobulinemic glomerulonephritis or immunotactoid glomerulopathy. Although the exact interrelationship among the peculiar glomerulopathy, cryoglobulinemia and chronic active hepatitis in the present case remains undetermined, this report enlarges the spectrum of glomerulopathy characterized by extracellular deposition of microtubules.- - - - - - - - - - ranking = 3keywords = hepatitis (Clic here for more details about this article) |
9/61. Membranous glomerulonephritis associated with active liver cirrhosis both involved by HBs antigen.This is a case report of a 35-year-old female who showed a relatively short clinical course of severe liver cirrhosis and proteinuria. On light microscopical studies of autopsy material, besides active postnecrotic type liver cirrhosis, typical membranous glomerulonephritis was found. Immunofluorescent study disclosed not only clustered HBsAg (hepatitis type B surface antigen) in occasional hepatic cells but also beaded granular type deposition of HBsAg, IgG, IgM, IgA and complement c3 along renal glomerular basement membrane (GBM). Electron microscopical study disclosed multiple particulated material in occasional inclusion bodies of hepatic cells and in subepithelial and subendothelial dense deposits along the GBM. Enzymatic immunoelectron microscopical study confirmed these particles especially along the GBM being HBsAg themselves. It was concluded that HBsAg-Ab (antibody) complex was the pathogenetic factor responsible for the glomerular change of this particular case. Although HBsAg and Ab were examined to be negative in serum throughout the patient's clinical course, the possibility of the presence of circulating HBsAg-Ab complex in serum was discussed.- - - - - - - - - - ranking = 0.5keywords = hepatitis (Clic here for more details about this article) |
10/61. hepatitis c virus-related cryoglobulinemic glomerulonephritis: long-term remission after antiviral therapy.BACKGROUND: Renal involvement in patients with hepatitis c virus (HCV) infection commonly manifests as cryoglobulinemic glomerulonephritis (CGN). The combination of interferon-alpha (IFN-alpha) and ribavirin, which is currently considered the standard antiviral therapy in chronic hepatitis c, could be difficult to carry out in cryoglobulinemic patients who are frequently anemic, even in the absence of renal failure. Clinical and histologic long-term results of this therapeutic regimen have not been so far reported in patients with CGN. methods: Three patients with HCV-related CGN and slightly impaired kidney function were treated with IFN-alpha and ribavirin for 12 months, and subsequently were followed up for 24 to 36 months. Two of these patients who were anemic were pretreated with erythropoietin (EPO). In each patient renal biopsy was performed before starting therapy and repeated 14 to 26 months after the end of treatment. RESULTS: In all three patients, antiviral therapy induced sustained virologic response, which was followed by clear improvement in clinical, biochemical, immunologic, and histologic features. Clinical and biochemical improvement steadily progressed in all three patients, achieving normal or nearly normal results at the end of follow-up. In contrast, some immunologic features, such as serum levels of C4 and rheumatoid factor activity, did not normalize in two and three patients, respectively. Posttreatment renal biopsies showed mildly active histologic lesions. CONCLUSION: Antiviral therapy with IFN-alpha and ribavirin may be considerably beneficial in patients with HCV-related CGN who obtain sustained virologic response.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
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