Monitoring of serum hepatitis C virus RNA level during steroid therapy for hepatitis C virus-positive antineutrophil cytoplasmic antibody-related glomerulonephritis: report of two cases

Abstract

We report on two adult patients with hepatitis C virus-positive antineutrophil cytoplasmic antibody-related glomerulonephritis. These patients had a renal-limited form of crescentic glomerulonephritis with high levels of serum hepatitis C virus RNA. We investigated the efficiency and transition of the serum levels of creatinine, hepatitis C virus RNA, and hepatic enzymes during corticosteroid therapy in the two patients. Corticosteroid therapy consisted of intravenous high-dose methylprednisolone for 3 days, followed by oral prednisolone without cyclophosphamide. During this course of treatment, renal function in both patients recovered remarkably. A marked increase in the level of hepatitis C virus RNA, however, was observed with or without an increase in serum levels of hepatic enzymes. It seems that steroid therapy for patients who have antineutrophil cytoplasmic antibody-related pauci-immune crescentic glomerulonephritis and high levels of hepatitis C virus RNA is efficient and relatively safe, although serum levels of hepatitis C virus RNA and liver function need to be carefully monitored.