Broad spectrum of interferon-related nephropathies-glomerulonephritis, systemic lupus erythematosus-like syndrome and thrombotic microangiopathy: A case report and review of literature

Table 1 Therapeutic indications of different IFN formulations

Type of IFN	Hepatological indications	Immunological indications	Neurological indications	Haematological indications	Neoplastic indications
IFN-α 2A and IFN-α 2B	HBV-CH, HCV-CH, HDV-CH	BS, ECD	No current indications	ET, PV, CML, NHL, HCL, CTCL, WM	aRCC, MM stage II, AIDS-associated Kaposi sarcoma
IFN-β 1A and IFN-β 1B	No current indications	No current indications	RRSM	No current indications	No current indications

aRCC: Advanced renal cell carcinoma; BS: Behçet syndrome; CML: Chronic myeloid leukaemia; CTCL: T-cell cutaneous lymphoma; ECD: Erdheim-Chester disease; ET: Essential thrombocythemia; HBC-CH: Hepatitis B virus-related chronic hepatitis; HCL: Hair-cell leukaemia; HCV-CH: Hepatitis C virus-related chronic hepatitis; HDV-CH: Hepatitis D virus-related chronic hepatitis in patients with hepatitis B virus co-infection; IFN: Interferon; MM: Malignant melanoma stage II (Tumour node metastasis classification, American Joint Committee on Cancer 2010); NHL: Non-Hodgkin’s lymphoma; PV: Polycythaemia vera; RRSM: Relapsing-remitting multiple sclerosis; WM: Waldenstrom macroglobulinemia.

Table 2 Clinical and laboratory findings of our case series: Medical history, diagnosis, treatment and outcome

	Case 1	Case 2	Case 3	Case 4
Age in yr	56	56	65	66
Sex	F	F	F	M
Type of IFN and time of exposure	IFN-β, 10 yr	IFN-β, 2 mo	IFN-α 2B, 4 yr; Peg-IFN-α 2B, 1 yr	Peg-IFN-α 2B, 2 yr
Indication for IFN treatment	RRMS	RRMS	HCV-related chronic hepatitis	HCV-related chronic hepatitis
Clinical presentation	Dyspnoea, severe hypertension, oedema of lower limbs, purpura	Chest pain and dyspnoea	Oedema of lower limbs and oliguria	Dyspnoea, lower limbs oedema, peripheral purpura, and itch
Serum creatinine at onset in mg/dL	4.5	2.5	3	0.83
Need for dialysis	Yes	No	No	No
Proteinuria in g/24 h	4	1.5	24	3.5
Renal biopsy	Thrombotic microangiopathy	Class IV-S (A/C) Lupus nephritis	Membranous nephropathy	Membranous nephropathy
Treatment, in addition to IFN discontinuation	Eculizumab	IV steroids, azathioprine	ACTH, RASS-B	No
Recurrence after IFN withdrawal	No	No	No	No
Outcome	ESRD	Remission	Remission	Remission
Length of follow-up in yr	3	4.5	12.5	5.5

ACTH: Adrenocorticotropic hormone; ESRD: End-stage renal disease; HCV: Hepatitis C virus; IFN: Interferon; IV: Intra-venous; RAAS-B: Renin-angiotensin-aldosterone system blockers; RRMS: Relapsing-remitting multiple sclerosis.