TY - JOUR
T1 - Multicenter Study on Hepatitis C Virus-Related Cryoglobulinemic Glomerulonephritis
AU - Roccatello, Dario
AU - Fornasieri, Alessandro
AU - Giachino, Osvaldo
AU - Rossi, Daniela
AU - Beltrame, Alessandra
AU - Banfi, Giovanni
AU - Confalonieri, Roberto
AU - Tarantino, Antonio
AU - Pasquali, Sonia
AU - Amoroso, Antonio
AU - Savoldi, Silvana
AU - Colombo, Valeriana
AU - Manno, Carlo
AU - Ponzetto, Antonio
AU - Moriconi, Luigi
AU - Pani, Antonello
AU - Rustichelli, Roberto
AU - Di Belgiojoso, Giovanni Barbiano
AU - Comotti, Chiara
AU - Quarenghi, Maria Ida
PY - 2007/1
Y1 - 2007/1
N2 - Background: Mixed cryoglobulinemia is a multisystem disorder associated strongly with hepatitis C virus (HCV) infection. The kidney frequently is involved, and glomerulonephritis represents the key factor affecting prognosis. Methods: Clinical, serological, immunogenetic, and morphological data were collected retrospectively from medical records of 146 patients with cryoglobulinemic glomerulonephritis who underwent biopsies in 25 Italian centers and 34 cryoglobulinemic controls without renal involvement. Results: Eighty-seven percent of patients were infected with HCV; genotype 1b was more frequent than genotype 2 (55% versus 43%). Diffuse membranoproliferative glomerulonephritis was the most prevalent histological pattern (83%). Type II cryoglobulin (immunoglobulin Mκ [IgMκ]/IgG) was detected in 74.4% of cases. The remainder had type III (polyclonal IgM/IgG) cryoglobulins. A multivariate Cox proportional hazard model showed that age, serum creatinine level, and proteinuria at the onset of renal disease were associated independently with risk for developing severe renal failure at follow-up. Overall survival at 10 years was about 80%. Kaplan-Meier survival curves were worsened by a basal creatinine value greater than 1.5 mg/dL (>133 μmol/L), but were unaffected by sex and HCV infection. Cardiovascular disease was the cause of death in more than 60% of patients. Conclusion: Data confirm the close association between mixed cryoglobulinemia and HCV infection and between glomerulonephritis and type II cryoglobulin. Survival profiles are better than previously reported in the literature, probably because of improvement in therapeutic regimens. Causes of death reflect this improvement in survival, with an increased prevalence of cardiovascular events compared with infectious complications and hepatic failure, which were predominant in the past.
AB - Background: Mixed cryoglobulinemia is a multisystem disorder associated strongly with hepatitis C virus (HCV) infection. The kidney frequently is involved, and glomerulonephritis represents the key factor affecting prognosis. Methods: Clinical, serological, immunogenetic, and morphological data were collected retrospectively from medical records of 146 patients with cryoglobulinemic glomerulonephritis who underwent biopsies in 25 Italian centers and 34 cryoglobulinemic controls without renal involvement. Results: Eighty-seven percent of patients were infected with HCV; genotype 1b was more frequent than genotype 2 (55% versus 43%). Diffuse membranoproliferative glomerulonephritis was the most prevalent histological pattern (83%). Type II cryoglobulin (immunoglobulin Mκ [IgMκ]/IgG) was detected in 74.4% of cases. The remainder had type III (polyclonal IgM/IgG) cryoglobulins. A multivariate Cox proportional hazard model showed that age, serum creatinine level, and proteinuria at the onset of renal disease were associated independently with risk for developing severe renal failure at follow-up. Overall survival at 10 years was about 80%. Kaplan-Meier survival curves were worsened by a basal creatinine value greater than 1.5 mg/dL (>133 μmol/L), but were unaffected by sex and HCV infection. Cardiovascular disease was the cause of death in more than 60% of patients. Conclusion: Data confirm the close association between mixed cryoglobulinemia and HCV infection and between glomerulonephritis and type II cryoglobulin. Survival profiles are better than previously reported in the literature, probably because of improvement in therapeutic regimens. Causes of death reflect this improvement in survival, with an increased prevalence of cardiovascular events compared with infectious complications and hepatic failure, which were predominant in the past.
KW - cryoglobulinemic glomerulonephritis
KW - cryoglobulins
KW - HCV syndrome
KW - hepatitis C virus (HCV)-associated glomerulonephritis
KW - membranoproliferative glomerulonephritis
KW - Mixed cryoglobulinemia
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U2 - 10.1053/j.ajkd.2006.09.015
DO - 10.1053/j.ajkd.2006.09.015
M3 - Article
C2 - 17185147
AN - SCOPUS:33845592773
VL - 49
SP - 69
EP - 82
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 1
ER -