Treatment of Hepatitis C-Induced Cryoglobulinemia

The treatment of hepatitis C-induced cryoglobulinemia can be broken down into two different arms, both of which are usually necessary:

1.  Antiviral Therapy, to get at the root-cause of the problem.

2.  Immunosuppression Therapy, to prevent the acute inflammation which is causing clinical symptoms, and often glomerulonephritis.  

It is often challenging to find the fine balance between these two treatment arms, as too much immmunosuppression will allow the hepatitis C virus to replicate unchecked, while the antiviral therapy may have unfortunate effects in certain renal patients.  

For instance, the best antiviral therapy available is a combination  of pegylated interferon plus ribavirin, which in the majority of patients is associated with a good initial response.  However, the use of ribavirin is contraindicated in patients with a GFR less than 50,  according to recent KDIGO guidelines, as a result of an increased rate of hemolytic anemia caused by this drug. 

In addition, patients with a kidney transplant should not be given interferon therapy, as it can lead to acute rejection.  This is why hepatitis C-positive patients who are seeking a kidney transplant should be strongly encouraged to get treatment for their hepatitis C before proceeding with kidney transplant.