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Infekce virem hepatitidy C (HCV) bývá spojena s extrahepatálními projevy až u 36 % nemocných, hlavně s kryoglobulinemií, trombopenickou purpurou a membranoproliferativní glomerulonefritidou. Smíšená kryoglobulinemie je charakterizována typickou klinickou trias (purpura, slabost, artralgie) a postižením jednoho nebo více orgánů nebo systémů (játra, ledviny a periferní nervy). Periferní neuropatie může být také asociována s HCV infekcí a obvykle souvisí se smíšenou kryoglobulinemií, ale byly popsány i neuropatie bez přítomnosti sérových kryoglobulinů. HCV-asociovaná neuropatie je obvykle axonální, typu chronické symetrické senzitivní nebo senzitivně-motorické polyneuropatie nebo subakutní mononeuropatie multiplex v důsledku vaskulitidy. Léčba pegylovaným interferonem-alfa a ribavirinem je většinou spojena se zlepšením jaterních parametrů a vaskulitických příznaků. V některých případech bylo ale pozorováno zhoršení nebo i nová manifestace periferní neuropatie. Tito pacienti se mohou zlepšit po rituximabu, který představuje alternativní léčbu.

Infection with the hepatitis C virus (HCV) can be associated with extrahepatic manifestations in as much as 36% of HCV patients, mainly with cryoglobulinemia, thrombopenic purpura, and membranoproliferative glomerulonephritis. The mixed cryoglobulinemia is characterized by a typical clinical triad (purpura, weakness, arthralgias) and by involvement of one or more organs or systems (liver, kidney, and peripheral nerve). Peripheral neuropathy may also be associated with HCV infection and it is usually related to mixed cryoglobulinaemia but neuropathies in the absence of serum cryoglobulins have also been described. HCV-associated neuropathy is usually an axonal-type chronic symmetrical sensory or sensorimotor polyneuropathy or a subacute mononeuropathy multiplex due to vasculitis. Treatment with pegylated interferon-alfa and ribavirin mostly is associated with an improvement of hepatic parameters and vasculitic symptoms. In some cases, worsening or even new onset of peripheral neuropathy was observed. These patients can improve with rituximab that represent an alternative treatment.

MeSH
hepatitida C farmakoterapie komplikace MeSH
interferon alfa škodlivé účinky terapeutické užití MeSH
kryoglobulinemie etiologie farmakoterapie MeSH
lidé MeSH
monoklonální protilátky aplikace a dávkování farmakologie terapeutické užití MeSH
nemoci periferního nervového systému etiologie farmakoterapie komplikace MeSH
polyneuropatie etiologie farmakoterapie komplikace MeSH
ribavirin škodlivé účinky terapeutické užití MeSH
Check Tag
lidé MeSH
Publikační typ
přehledy MeSH

Článek

Postižení ledvin u primárního Sjögrenova syndromu
[Renal involvement in primary Sjögren's syndrome: a clinicopathologic study]

Postgraduální nefrologie. 2009 ; 7 (6) : 88-89.

ISSN 1214-178X
Medvik
Zdroj

Renal pathology and clinical outcomes in patients with primary Sjögren's syndrome (pSS) who underwent kidney biopsy (KB) because of renal impairment are reported. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Twenty-four of 7276 patients with pSS underwent KB over 40 years. Patient cases were reviewed by a renal pathologist, nephrologist, and rheumatologist. Presentation, laboratory findings, renal pathology, initial treatment, and therapeutic response were noted. RESULTS: Seventeen patients (17 of 24; 71%) had acute or chronic tubulointerstitial nephritis (TIN) as the primary lesion, with chronic TIN (11 of 17; 65%) the most common presentation. Two had cryoglobulinemic GN. Two had focal segmental glomerulosclerosis. Twenty patients (83%) were initially treated with corticosteroids. In addition, three received rituximab during follow-up. Sixteen were followed after biopsy for more than 12 mo (median 76 mo; range 17 to 192), and 14 of 16 maintained or improved renal function through follow-up. Of the seven patients presenting in stage IV chronic kidney disease, none progressed to stage V with treatment. CONCLUSIONS: This case series supports chronic TIN as the predominant KB finding in patients with renal involvement from pSS and illustrates diverse glomerular lesions. KB should be considered in the clinical evaluation of kidney dysfunction in pSS. Treatment with glucocorticoids or other immunosuppressive agents appears to slow progression of renal disease. Screening for renal involvement in pSS should include urinalysis, serum creatinine, and KB where indicated. KB with characteristic findings (TIN) should be considered as an additional supportive criterion to the classification criteria for pSS because it may affect management and renal outcome.