Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis
Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis
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DOI：
10.2215/cjn.07311009
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发表时间：
2010-04-01
影响因子：
9.8
通讯作者：
D'Agati, Vivette D.
中科院分区：
文献类型：
--
作者：
Markowitz, Glen S.;Nasr, Samih H.;D'Agati, Vivette D.
背景和目标：IFN治疗很少与肾病综合征和肾活检结果的微小变化疾病或FSGS.Design，设置，参与者，和measurements：我们报告了11例崩溃FSGS的IFN治疗过程中发展和改善后，停止therapeutic.Results：该队列由7名女性和4名男性，平均年龄为48.2岁。11名患者中有10名是黑人。6例患者接受IFN-α治疗丙型肝炎病毒感染（n = 5）或恶性黑色素瘤（n = 1），3例接受IFN-β治疗多发性硬化症，2例接受IFN-γ治疗特发性肺纤维化。平均和中位治疗时间分别为4.0和12.6个月后，患者出现急性肾衰竭（平均肌酐3.5 mg/dl）和肾病范围蛋白尿（平均24小时尿蛋白9.7 g）。肾活检显示塌陷的FSGS，伴有广泛的足突消失和许多内皮小管网状包涵体。随访10例患者，均停用IFN。在平均23.6个月时，10例患者中有9例肾功能改善，包括1例完全缓解和2例部分缓解。在7例有可用数据的患者中，平均蛋白尿从9.9 g/d降至3.0 g/d。七名患者中有四人接受免疫抑制治疗，并没有检测到的benefit.Conclusions：塌陷FSGS可能发生在治疗后与IFN-α，-β，或-γ，通常伴随着内皮tubuloreticular夹杂物的超微结构的发现。最佳治疗包括停用IFN。Clin J Am Soc Nephrol 5：607-615，2010. doi：10.2215/CJN.07311009
Background and objectives: Treatment with IFN is rarely associated with nephrotic syndrome and renal biopsy findings of minimal-change disease or FSGS.Design, setting, participants, & measurements: We report 11 cases of collapsing FSGS that developed during treatment with IFN and improved after discontinuation of therapy.Results: The cohort consists of seven women and four men with a mean age of 48.2 yr. Ten of the 11 patients were black. Six patients were receiving IFN-alpha for hepatitis C virus infection (n = 5) or malignant melanoma (n = 1), three were receiving IFN-beta for multiple sclerosis, and two were treated with IFN-gamma for idiopathic pulmonary fibrosis. After a mean and median duration of therapy of 4.0 and 12.6 months, respectively, patients presented with acute renal failure (mean creatinine 3.5 mg/dl) and nephrotic-range proteinuria (mean 24-hour urine protein 9.7 g). Renal biopsy revealed collapsing FSGS with extensive foot process effacement and many endothelial tubuloreticular inclusions. Follow-up was available for 10 patients, all of whom discontinued IFN. At a mean of 23.6 months, nine of 10 patients had improvement in renal function, including one with complete remission and two with partial remission. Among the seven patients with available data, mean proteinuria declined from 9.9 to 3.0 g/d. Four of the seven patients were treated with immunosuppression, and there was no detectable benefit.Conclusions: Collapsing FSGS may occur after treatment with IFN-alpha, -beta, or -gamma and is typically accompanied by the ultrastructural finding of endothelial tubuloreticular inclusions. Optimal therapy includes discontinuation of IFN. Clin J Am Soc Nephrol 5: 607-615, 2010. doi: 10.2215/CJN.07311009