Kidney Problems

[mommaglow]

Hey- just a quick question, can any of the tx meds for Hep C cause kidney problems? I just have had some issues lately and was wondering if they could be linked to tx.

[alagirl]

I've seen info to suggest that for patients with renal failure, it is preferred to do monotherapy (interferon alone), because the ribavirin can enhance the renal problems.  Of course, you would want to talk to your doctor about this.  Post transplant patients (renal) are frequently warned away from treating due to fear of causing the tp to fail.

Here's a link and abstract:

http://cjasn.asnjournals.org/cgi/content/abstract/2/3/563

Liver disease secondary to chronic hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in dialysis patients and kidney transplant recipients. Evaluation of patients with chronic HCV infection is warranted to determine stage of disease and the need for HCV therapy. Although combination therapy with interferon (IFN) plus ribavirin is the standard of care for chronic HCV infection, IFN monotherapy is recommended in dialysis patients because ribavirin is contraindicated in the presence of renal failure. The goals of pretransplantation HCV therapy are to decrease the risk for progression of HCV-associated liver disease, stabilize renal function in patients with HCV-related glomerulopathy, and prevent development of HCV-associated renal disease after transplantation. Posttransplantation HCV therapy is generally not recommended because of concerns regarding risk for precipitating acute rejection; however, antiviral therapy may be indicated to treat HCV-related glomerulopathy or prevent progression of chronic hepatitis C in patients with more advanced stages of fibrosis. When treatment is required, restored renal function allows use of combination therapy with IFN and ribavirin. Limitations of current HCV therapy include lack of tolerability and suboptimal response rates. New antiviral agents that can be used in dialysis patients (e.g., ribavirin alternatives) and in the posttransplantation setting (e.g., IFN alternatives) are needed to improve outcomes in these populations.

[alagirl]

Here is some information regarding the use of rituxan to aid in the renal health of hcv patients:

http://www.uptodate.com/patients/content/abstract.do;jsessionid=35F30559346417390FFF441481897210.1002;jsessionid=35F30559346417390FFF441481897210.1002?topicKey=~dLMLcfjxuNtgqR0&refNum=57

Medline ® Abstract for Reference 57
of 'Renal disease with hepatitis C virus infection'
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57  
TI Rituximab therapy for mixed cryoglobulinemia in seven renal transplant patients.  
AU Basse G; Ribes D; Kamar N; Mehrenberger M; Sallusto F; Esposito L; Guitard J; Lavayssiere L; Oksman F; Durand D; Rostaing L  
SO Transplant Proc. 2006 Sep;38(7):2308-10.  
  
  Systemic B-cell depletion and clinical remission of the systemic effects of cryoglobulins have been achieved in hepatitis C virus-positive immunocompetent patients with rituximab, a human/mouse chimeric monoclonal antibody that specifically reacts with the CD20 antigen. Thus, this provides a rationale for the use of rituximab for type III cryoglobulin-related graft dysfunction in renal-transplant patients. Seven patients, of whom five were hepatitis C positive, developed renal function impairment long after transplantation, as well as de novo nephrotic syndrome (n = 5), severe hypertension (n = 5), nephritic syndrome (n = 1), and increased serum creatinine (n = 1). This type III cryoglobulinemia was associated with membranoproliferative glomerulonephritis and with thrombi within the glomeruli in one case. In addition to their baseline standard immunosuppressive medications, the patients were given weekly rituximab infusions: 375 mg/m(2) for 2 weeks in four cases, for 3 weeks in one case, and for 4 weeks in two cases. This treatment resulted in a dramatic improvement in all renal parameters, particularly a sustained remission of nephrotic syndrome in three cases, the disappearance of nephritic syndrome in one patient, and improved nephrotic syndrome in two cases, as well as a sustained clearance of cryoglobulins in six cases. However, it also resulted in severe infectious complications in two cases. We concluded that rituximab therapy is effective in cryoglobulin-related renal dysfunction in renal transplant patients but, due to chronic immunosuppression, this may be achieved at the expense of infectious complications.  
  
AD Multiorgan Transplant Unit, University Hospital, CHU Rangueil, 1 avenue Jean Poulhes, TSA 50032, 31059 Toulouse cedex 9, France.  
PMID 16980074