Ассоциированный с HCV-инфекцией криоглобулинемический васкулит с поражением почек – современные подходы к диагностике и лечению
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Milovanova S.Yu., Kozlovskaya (Lysenko) L.V., Milovanova L.Yu., et al. Hepatitis C virus-related cryoglobulinemic vasculitis with renal involvement current possibilities of diagnostic and treatment. Therapeutic Archive. 2019; 91 (6): 124–130.
DOI: 10.26442/00403660.2019.06.000254
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Ключевые слова: хронический гепатит С, смешанная криоглобулинемия, гломерулонефрит, противовирусная терапия, препараты прямого противовирусного действия, ритуксимаб.
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The extrahepatic manifestations of HCV infections, which include mixed cryoglobulinemia (MC), are important for prognosis and determination of the treatment options of these patients. Currently, mixed MC type II is considered as a specific marker of chronic HCV infection. Kidney damage is one of the severe, often determining a prognosis of extrahepatic manifestation of HCV-associated cryoglobulinemic vasculitis. The review discusses the current diagnostic approaches to cryoglobulinemic GN, as well as perspectives for improving antiviral and pathogenetic therapy.
Keywords: chronic hepatitis C, mixed cryoglobulinemia, glomerulonephritis, antiviral therapy, direct acting antiviral, rituximab.
2. Meltzer M, Franklin EC, Elisa K, et al. Cryoglobulinemia – a clinical and laboratory study. II. Cryoglobulins with rheumatoid factor activity. Am J Med. 1966;40:837-56. PMID: 4956871
3. Brouet JC, Clouvel JP, Danon F, et al. Biologic and clinical significance of cryoglobulins. Am J Med. 1974;57:775-88. PMID: 4216269
4. Agnello V, Romain PL. Mixed cryoglobulinemia secondary to hepatitis C virus infection. Reum Dis Clin North Am. 1996;22(1):1-21. PMID: 8907062
5. Ferri C, Mascia MT. Cryoglobulinemic vasculitis: Review. Curr Opin Rheumatol. 2006;18:54-63. PMID: 4216269
6. D’Amico G. Renal involvement in hepatitis С infection: Cryoglobulinemic glomerulonephritis. Kidney Int. 1998;54:650-87. PMID: 9690235
7. Charles ED, Dustin LB. Hepatitis C virus induced cryoglobulinemia. Kidney Int. 2009;76(8):818-24. doi: 10.1038/ki.2009.247
8. Ferri C. Mixed cryoglobulinemia. Orphanet J Rare. 2008;3:25. doi: 10.1186/1750-1172-3-25
9. Тэгай С.В., Лопаткина Т.Н., Косминкова Е.Н., Козловская Л.В. Поражение почек, ассоциированное с вирусами гепатитов В и С. Consilium Med. 2002;4(7):337-41 [Tegay SV, Lopatkina ТN, Kosminkova ЕN, Кozlovskaya LV. Kidney damage associated with hepatitis B and C viruses. Consilium Med. 2002;4(7):337-41 (In Russ.)].
10. Saadoun D, Landau DA, Calabrese LH, Cacoub P. Hepatitis C-associated mixed cryoglobulinemia: a crossroad between autoimmunity and lymphoproliferation. Rheumatology. 2007;46:1234-42. doi: 10.1093/rheumatology/kem132
11. Милованова С.Ю., Игнатова Т.М., Козловская Л.В. Особенности течения хронического гепатита С с криоглобулинемией. Клиническая гепатология. 2006;2(1):15-8 [Milovanova SYu, Ignatova ТM, Kozlovskaya LV. Features of the course of chronic hepatitis C with cryoglobulinemia. Clinical Hepatology. 2006;2(1):15-8 (In Russ.)].
12. Cacoub P, Poynard T, Ghillani P, et al. Extrahepatic manifestations of chronic hepatitis c. MULTIVIRC Group. Multidepartment Virus C. Arthritis Rheum. 1999;42:2204-12. doi: 10.1002/1529-0131
13. McGuire BM, Julian BA, Bynon JS, et al. Brief communication: Glomerulonephritis in patients with hepatitis C cirrhosis undergoing liver transplantation. Ann Intern Med. 2006;144:735-41. PMID: 16702589
14. Arase Y, Ikeda K, Murashima N, et al. Glomerulonephritis in autopsy cases with hepatitis C virus infection. Intern Med. 1998;37:836-40. doi: 10.2169/internalmedicine.37.836
15. Jonson RJ, Gretch DR, Couser WG, et al. Hepatitis C virus-associated glomerulonephritis. Effect of α-interferon therapy. Kidney Int. 1994;46:1700-4. PMID: 7535369
16. Trejo O, Ramos-Casals M, Garcia-Carrasco M. Cryoglobulinemia: study of etiologic factors and clinical and immunologic in 443 patients fr om a simple center. Medicine. 2001;8:252-62. PMID: 11470986
17. Cacoub P, Delluc A, Saadoun D, et al. Anti-CD20 monoclonal antibody (rituximab) treatment for cryoglobulinemic vaskulitis: wh ere do we stand? Ann Rheum Dis. 2008;67(3):283-7. doi: 10.1136/ard.2006.065565
18. Ferri C, Sebastiani M, Antonelli A, et al. Current treatment of hepatitis C-associated rheumatic diseases. Arthritis Res Ther. 2012;14:215-21. doi: 10.1186/ar3865
19. Милованова С.Ю., Лысенко (Козловская) Л.В., Милованова Л.Ю., Мрыхин Н.Н., Русских А.В. HCV-ассоциированная смешанная криоглобулинемия и В-клеточная неходжкинская лимфома – патогенетически связанные проблемы. Терапевтический архив. 2018;(6):112-21 [Milovanova SYu, Lysenko (Kozlovskaya) LV, Milovanova LYu, Mrykhin NN, Muchin NA, Russkih AV. HCV-associated mixed cryoglobulinemia and b-cell non-Hodgkin's lymphoma – pathogenetically related problems. Therapeutic Archive. 2018 Jun 20;90(6):112–20 (In Russ.)]. doi: 10.26442/terarkh2018906112-120
20. Игнатова Т.М., Козловская Л.В., Гордовская Н.Б., Чернова О.А., Милованова С.Ю., Новиков П.И., Некрасова Т.П., Бекетова Т.В., Мухин Н.А. Криоглобулинемический васкулит, ассоциированный с вирусом гепатита С: 20-летний опыт лечения. Терапевтический архив. 2017;89(5):46-52 [Ignatova TM, Kozlovskaya LV, Gordovskaya NB, Chernova OA, Milovanova SYu, Novikov PI, Nekrasova TP, Beketova TV, Mukhin NA. Hepatitis C virus-associated cryoglobulinemic vasculitis: A 20-year experience with treatment. Therapeutic Archive. 2017;89(5):46-52 (In Russ.)]. doi: 10.17116/terarkh201789546-52
21. Emery JS, Kuczynsky M, La D, et al. Efficacy and safety of direct acting antiviral for the treatment of mixed cryoglobulinemia. Am J Gastroenterol. 2017;112:1298-308. doi:10.1038/ajg.2017.49
22. Saadoun D, Pol S, Ferfar Y, et al. Efficacy and safety of sofosbuvir plus daclatasvir for treatment of HCV-associated cryoglobulinemia vasculitis. Gastroenterol Hepatol. 2017;15:575-83. doi:10.1053/j.gastro.2017.03.006
23. Gragnani L, Piluso A, Urraro T, et al. Virological and clinical response to interferon-free regimens in patients with HCV-related mixed cryoglobulinemia:preliminary results of a prospective pilot study. Curr Drug Targets. 2017;18:772-85. doi: 10.2174/1389450117666160208145432
24. Jean-Michel Pawlotsky, Alessio Aghemo, Geoffrey Dusheiko, Xavier Forns, Massimo Puoti, Christophe Sarrazin. EASL Recommendations on Treatment of Hepatitis C 2018. European Association for the Study of the Liver (EASL). doi: 10.1016/j.jhep.2018.03.026
25. Executive summary of the 2018 KDIGO hepatitis C in CKD Guideline: welcoming advances in evaluation and management. Kidney Int. 2018;94:663-73. doi: 10.1016/j.kisu.2018.06.001
26. Saxena V, Koraishy FM, Sise ME, et al. Safety and efficacy of sofosbuvir-containing regimens in hepatitis C-infected patients with impaired renal function. Liver Int. 2016;36:807-16. doi: 10.1111/liv.13102
27. Nazario HE, Ndungu M, Modi AA. Sofosbuvir and simeprevir in hepatitis C genotype 1 – patients with end-stage renal disease on haemodialysis or GFR<30 ml/min. Liver Int. 2016;36:798-801. doi: 10.1111/liv.13025
28. Li T, Qu Y, Guo Y, Wang L. Efficacy and safety of direct acting antiviral therapies for hepatitis C virus patients with stage 4-5 chronic kidney disease: A meta-analysis. Liver Int. 2016;37:974-81. doi: 10.1111/liv.13336
29. Comarmond C, Garrido M, Pol S, et al. Direct-acting antiviral therapy restores immune tolerance to patients with hepatitis C virus-induced cryoglobulinemia vasculitis. Gastroenterology. 2017;152:2052-62. doi: 10.1053/j.gastro.2017;02.037
30. Sise ME, Bloom AK, Wisocky J, Chung RT. Treatment of Hepatitis C Virus-Associated Mixed Cryoglobulinemia with Sofosbuvir-Based Direct-Acting Antiviral Agents. Hepatology. 2015;63:408-17. doi: 10.1002/hep.28297
31. Rutlenge SM, Chung RT, Sise ME. Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis. Hemodialysis Int. 2018;22:81-96. doi: 10.1111/hdi.12649
32. Cornella SL, Stine JG, Kelly V, Caldwell SH, ShahNL. Persistence of mixed cryoglobulinemia despitecure of hepatitis C with new oral antiviral therapyincluding direct-acting antiviral sofosbuvir: A caseseries. Postgrad Med. 2015;127:413-7.
33. Saadoun D, Thibault V, Ahmed SNS, et al. Sofosbuvir plus ribavirin for hepatitis C virus-associated cryoglo-bulinaemia vasculitis: VASCUVALDIC study. Ann Rheum Dis. 2015;75:1777-82.
34. Cacoub P, Ahmed SA, Ferfar Y, Pol S, et al. long-term efficacy of interferon-tree antiviral treatment regimens in patients with hepatitis C virus-associated cryoglobulinemia vasculitis. Clin Gastroenterol Hepatol. 2019;17:518-26. doi: 10.1016/j.cgh.2018.05.021
35. Landau D, Saadoun D, Halfon P, et al. Relapse of hepatitis C virus-associated mixed cryoglobulinemia vasculitis in patients with sustained viral response. Arthritis Rheum. 2008;58(2):604-11. doi: 10.1002/art.23305
36. Giannini C, Petrarca A, Monti M, et al. Associated between persistent lymphatic infection by hepatitis C virus after antiviral treatment and mixed cryoglobulinemia. Blood. 2008;111:2943-5. doi: 10.1182/blood-2007-09-112490
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1. Gorevic PD, Kassab HJ, Levo Y, et al. Mixed cryoglobulinemia: Clinical aspects and long-term follow-up of 40 patients. Am J Med. 1980;69:287-308. PMID: 6996482
2. Meltzer M, Franklin EC, Elisa K, et al. Cryoglobulinemia – a clinical and laboratory study. II. Cryoglobulins with rheumatoid factor activity. Am J Med. 1966;40:837-56. PMID: 4956871
3. Brouet JC, Clouvel JP, Danon F, et al. Biologic and clinical significance of cryoglobulins. Am J Med. 1974;57:775-88. PMID: 4216269
4. Agnello V, Romain PL. Mixed cryoglobulinemia secondary to hepatitis C virus infection. Reum Dis Clin North Am. 1996;22(1):1-21. PMID: 8907062
5. Ferri C, Mascia MT. Cryoglobulinemic vasculitis: Review. Curr Opin Rheumatol. 2006;18:54-63. PMID: 4216269
6. D’Amico G. Renal involvement in hepatitis С infection: Cryoglobulinemic glomerulonephritis. Kidney Int. 1998;54:650-87. PMID: 9690235
7. Charles ED, Dustin LB. Hepatitis C virus induced cryoglobulinemia. Kidney Int. 2009;76(8):818-24. doi: 10.1038/ki.2009.247
8. Ferri C. Mixed cryoglobulinemia. Orphanet J Rare. 2008;3:25. doi: 10.1186/1750-1172-3-25
9. Tegay SV, Lopatkina ТN, Kosminkova ЕN, Кozlovskaya LV. Kidney damage associated with hepatitis B and C viruses. Consilium Med. 2002;4(7):337-41 (In Russ.)
10. Saadoun D, Landau DA, Calabrese LH, Cacoub P. Hepatitis C-associated mixed cryoglobulinemia: a crossroad between autoimmunity and lymphoproliferation. Rheumatology. 2007;46:1234-42. doi: 10.1093/rheumatology/kem132
11. Milovanova SYu, Ignatova ТM, Kozlovskaya LV. Features of the course of chronic hepatitis C with cryoglobulinemia. Clinical Hepatology. 2006;2(1):15-8 (In Russ.)
12. Cacoub P, Poynard T, Ghillani P, et al. Extrahepatic manifestations of chronic hepatitis c. MULTIVIRC Group. Multidepartment Virus C. Arthritis Rheum. 1999;42:2204-12. doi: 10.1002/1529-0131
13. McGuire BM, Julian BA, Bynon JS, et al. Brief communication: Glomerulonephritis in patients with hepatitis C cirrhosis undergoing liver transplantation. Ann Intern Med. 2006;144:735-41. PMID: 16702589
14. Arase Y, Ikeda K, Murashima N, et al. Glomerulonephritis in autopsy cases with hepatitis C virus infection. Intern Med. 1998;37:836-40. doi: 10.2169/internalmedicine.37.836
15. Jonson RJ, Gretch DR, Couser WG, et al. Hepatitis C virus-associated glomerulonephritis. Effect of α-interferon therapy. Kidney Int. 1994;46:1700-4. PMID: 7535369
16. Trejo O, Ramos-Casals M, Garcia-Carrasco M. Cryoglobulinemia: study of etiologic factors and clinical and immunologic in 443 patients fr om a simple center. Medicine. 2001;8:252-62. PMID: 11470986
17. Cacoub P, Delluc A, Saadoun D, et al. Anti-CD20 monoclonal antibody (rituximab) treatment for cryoglobulinemic vaskulitis: wh ere do we stand? Ann Rheum Dis. 2008;67(3):283-7. doi: 10.1136/ard.2006.065565
18. Ferri C, Sebastiani M, Antonelli A, et al. Current treatment of hepatitis C-associated rheumatic diseases. Arthritis Res Ther. 2012;14:215-21. doi: 10.1186/ar3865
19. Milovanova SYu, Lysenko (Kozlovskaya) LV, Milovanova LYu, Mrykhin NN, Muchin NA, Russkih AV. HCV-associated mixed cryoglobulinemia and b-cell non-Hodgkin's lymphoma – pathogenetically related problems. Therapeutic Archive. 2018 Jun 20;90(6):112–20 (In Russ.) doi: 10.26442/terarkh2018906112-120
20. Ignatova TM, Kozlovskaya LV, Gordovskaya NB, Chernova OA, Milovanova SYu, Novikov PI, Nekrasova TP, Beketova TV, Mukhin NA. Hepatitis C virus-associated cryoglobulinemic vasculitis: A 20-year experience with treatment. Therapeutic Archive. 2017;89(5):46-52 (In Russ.) doi: 10.17116/terarkh201789546-52
21. Emery JS, Kuczynsky M, La D, et al. Efficacy and safety of direct acting antiviral for the treatment of mixed cryoglobulinemia. Am J Gastroenterol. 2017;112:1298-308. doi:10.1038/ajg.2017.49
22. Saadoun D, Pol S, Ferfar Y, et al. Efficacy and safety of sofosbuvir plus daclatasvir for treatment of HCV-associated cryoglobulinemia vasculitis. Gastroenterol Hepatol. 2017;15:575-83. doi:10.1053/j.gastro.2017.03.006
23. Gragnani L, Piluso A, Urraro T, et al. Virological and clinical response to interferon-free regimens in patients with HCV-related mixed cryoglobulinemia:preliminary results of a prospective pilot study. Curr Drug Targets. 2017;18:772-85. doi: 10.2174/1389450117666160208145432
24. Jean-Michel Pawlotsky, Alessio Aghemo, Geoffrey Dusheiko, Xavier Forns, Massimo Puoti, Christophe Sarrazin. EASL Recommendations on Treatment of Hepatitis C 2018. European Association for the Study of the Liver (EASL). doi: 10.1016/j.jhep.2018.03.026
25. Executive summary of the 2018 KDIGO hepatitis C in CKD Guideline: welcoming advances in evaluation and management. Kidney Int. 2018;94:663-73. doi: 10.1016/j.kisu.2018.06.001
26. Saxena V, Koraishy FM, Sise ME, et al. Safety and efficacy of sofosbuvir-containing regimens in hepatitis C-infected patients with impaired renal function. Liver Int. 2016;36:807-16. doi: 10.1111/liv.13102
27. Nazario HE, Ndungu M, Modi AA. Sofosbuvir and simeprevir in hepatitis C genotype 1 – patients with end-stage renal disease on haemodialysis or GFR<30 ml/min. Liver Int. 2016;36:798-801. doi: 10.1111/liv.13025
28. Li T, Qu Y, Guo Y, Wang L. Efficacy and safety of direct acting antiviral therapies for hepatitis C virus patients with stage 4-5 chronic kidney disease: A meta-analysis. Liver Int. 2016;37:974-81. doi: 10.1111/liv.13336
29. Comarmond C, Garrido M, Pol S, et al. Direct-acting antiviral therapy restores immune tolerance to patients with hepatitis C virus-induced cryoglobulinemia vasculitis. Gastroenterology. 2017;152:2052-62. doi: 10.1053/j.gastro.2017;02.037
30. Sise ME, Bloom AK, Wisocky J, Chung RT. Treatment of Hepatitis C Virus-Associated Mixed Cryoglobulinemia with Sofosbuvir-Based Direct-Acting Antiviral Agents. Hepatology. 2015;63:408-17. doi: 10.1002/hep.28297
31. Rutlenge SM, Chung RT, Sise ME. Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis. Hemodialysis Int. 2018;22:81-96. doi: 10.1111/hdi.12649
32. Cornella SL, Stine JG, Kelly V, Caldwell SH, ShahNL. Persistence of mixed cryoglobulinemia despitecure of hepatitis C with new oral antiviral therapyincluding direct-acting antiviral sofosbuvir: A caseseries. Postgrad Med. 2015;127:413-7.
33. Saadoun D, Thibault V, Ahmed SNS, et al. Sofosbuvir plus ribavirin for hepatitis C virus-associated cryoglo-bulinaemia vasculitis: VASCUVALDIC study. Ann Rheum Dis. 2015;75:1777-82.
34. Cacoub P, Ahmed SA, Ferfar Y, Pol S, et al. long-term efficacy of interferon-tree antiviral treatment regimens in patients with hepatitis C virus-associated cryoglobulinemia vasculitis. Clin Gastroenterol Hepatol. 2019;17:518-26. doi: 10.1016/j.cgh.2018.05.021
35. Landau D, Saadoun D, Halfon P, et al. Relapse of hepatitis C virus-associated mixed cryoglobulinemia vasculitis in patients with sustained viral response. Arthritis Rheum. 2008;58(2):604-11. doi: 10.1002/art.23305
36. Giannini C, Petrarca A, Monti M, et al. Associated between persistent lymphatic infection by hepatitis C virus after antiviral treatment and mixed cryoglobulinemia. Blood. 2008;111:2943-5. doi: 10.1182/blood-2007-09-112490
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
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S.Yu. Milovanova, L.V. Kozlovskaya (Lysenko), L.Yu. Milovanova, N.B. Gordovskaya, T.M. Ignatova, M.V. Taranova, T.V. Androsova
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia