Figure 924

The proposed treatment for mixed cryoglobulinemia associated with hepatitis C virus infection in the presence of severe acute signs of renal involvement, ie, glomerulonephritis and vascultits. Plasma exchange is used only when acute renal insufficiency caused by massive precipitation of cryoglobulins is present. Interferon-a is given for more than 6 months only when negation of hepatitis C virus RNA is achieved in the first months, suggesting a beneficial effect on the viremia. Only the antiviral treatment with interferon-a eventually associated with low doses of steriods to conrol the systemic signs of mixed cryoglobulinemias should be given if renal involvement is mild. The association of interferon-a with another antiviral agent ribavirin, 0.6 to 1.0 g/d orally, now is being tested in patients with hepatitis C virus infection, with promising results [20].

Infection by HCV Emergence of a permanent clone producing IgMk RF

Infection by HCV Emergence of a permanent clone producing IgMk RF

B lymphocyte

Serum

Deposition of anti-HCV immune complexes

Precipitation of the circulating type II cryo

in situ binding of HCV-igG Ab to predeposited igMk

MPGN without cryoglobulinemia

Cryoglobulinemic GN

Glomerulus

Glomerulus

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