Gianassi I, Allinovi M, Caroti L, Cirami LC. Broad spectrum of interferon-related nephropathies-glomerulonephritis, systemic lupus erythematosus-like syndrome and thrombotic microangiopathy: A case report and review of literature. World J Nephrol 2019; 8(7): 109-117 [PMID: 31750091 DOI: 10.5527/wjn.v8.i7.109]
Corresponding Author of This Article
Marco Allinovi, MD, Doctor, Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Largo G. Brambilla, 3, Florence 50144, Italy. allinovim@aou-careggi.toscana.it
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Nov 12, 2019; 8(7): 109-117 Published online Nov 12, 2019. doi: 10.5527/wjn.v8.i7.109
Broad spectrum of interferon-related nephropathies-glomerulonephritis, systemic lupus erythematosus-like syndrome and thrombotic microangiopathy: A case report and review of literature
Iacopo Gianassi, Marco Allinovi, Leonardo Caroti, Lino Calogero Cirami
Iacopo Gianassi, Marco Allinovi, Leonardo Caroti, Lino Calogero Cirami, Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence 50144, Italy
Author contributions: All authors designed the study and wrote the protocol; Gianassi I and Caroti L identified studies and independently reviewed each for eligibility in a two-step based process; Gianassi I extracted the data and assessed the quality of selected studies using the checklist developed by Downs and Black for both randomized and non-randomized studies; Allinovi M supervised the data by using an ad hoc developed data extraction spreadsheet; Gianassi I, Allinovi M and Caroti L were involved in drafting of the manuscript; Cirami LC revised the manuscript; Allinovi M has given final approval of the version to be published; all authors read and approved the final manuscript.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: Gianassi I, Allinovi M, Caroti L and Cirami LC report no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marco Allinovi, MD, Doctor, Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Largo G. Brambilla, 3, Florence 50144, Italy. allinovim@aou-careggi.toscana.it
Telephone: +39-34-79950110
Received: June 6, 2019 Peer-review started: June 10, 2019 First decision: August 2, 2019 Revised: September 4, 2019 Accepted: September 22, 2019 Article in press: September 22, 2019 Published online: November 12, 2019 Processing time: 158 Days and 17.1 Hours
Abstract
BACKGROUND
Interferons (IFNs) are characterized by a wide range of biological effects, which justifies their potential therapeutic use in several pathologies, but also elicit a wide array of adverse effects in almost every organ system. Among them, renal involvement is probably one of the most complex to identify.
CASE SUMMARY
We describe four cases of kidney damage caused by different IFN formulations: IFN-β-related thrombotic microangiopathy, IFN-β-induced systemic lupus erythematosus, and two cases of membranous nephropathy secondary to pegylated-IFN-α 2B. In each case, we carefully excluded any other possible cause of renal involvement. Once suspected as the casual relationship between drug and kidney damage, IFN treatment was immediately discontinued. In three cases, we observed a complete and persistent remission of clinical and laboratory abnormalities after IFN withdrawal, while the patient who developed thrombotic microangiopathy, despite IFN withdrawal and complement-inhibitor therapy with eculizumab, showed persistent severe renal failure requiring dialysis.
CONCLUSION
This case series highlights the causal relationship between IFN treatment and different types of renal involvement and enables us to delineate several peculiarities of this association.
Core tip: Different patterns of kidney damage can occur in patients treated with different interferon types, even after years of well-tolerated therapy. Interferon can cause renal dysfunction which ranges from subclinical to severe dysfunction and, regardless the mechanism of renal failure, the usual pathological finding includes either podocytopathies, interstitial nephritis, systemic lupus erythematosus-like disease or thrombotic microangiopathy. We describe four cases of interferon-related nephropathies and for each case we highlight clinical features, laboratory work-up, histological findings, treatment and follow-up. Moreover, we report for the first time a case of drug-induced systemic lupus erythematosus with renal involvement after the use of interferon-β.
