[Hepatitis virus-related nephropathies]. / Virus epatitici e nefropatie correlate.

The extrahepatic manifestations of hepatitis B virus infection include reactive arthritis, vasculitis (panarteritis nodosa) and primary glomerulonephritis (membranous nephropathy, membranoproliferative glomerulonephritis and, less frequently, IgA nephropathy, focal and segmental glomerulosclerosis, minimal change disease, and extracapillary glomerulonephritis). No specific histomorphological patterns have been reported in association with HDV infection. Cryoglobulinemic glomerulonephritis is the only pattern of glomerular involvement unequivocally related to HCV infection. The treatment of HBV-related glomerulopathies is essentially antiviral. Corticosteroids have been proven to be ineffective (except in panarteritis nodosa), while immunosuppressants can lead to exacerbation of HBV infection. The treatment of HCV-related nephritis, especially cryoglobulinemic glomerulonephritis, encompasses various options including both conventional and novel immunomodulatory agents, possibly combined with antiviral therapy.

Deferiprone.

Deferiprone (DFP) has been evaluated in a wide range of disorders, but most data come from transfusion-dependent thalassemia. The safety and tolerability profile includes gastrointestinal complaints, liver enzymes elevation, weight gain, arthropathy, neutropenia, and agranulocytosis. The last requires close monitoring of blood count and precludes the use of DFP in conditions with bone marrow abnormalities. The efficacy profile is similar among the three available chelators. For DFP, the choice of dosage is crucial to optimize the effect on liver iron concentration, according to the iron load degree and transfusional iron input. Growing evidence indicates that DFP, alone or in combination with deferoxamine, is effective in removing cardiac iron and preventing cardiac iron load. The available data consolidate an important role of DFP in the management of iron overload. There is a need to compare directly the relative value of the available chelators in the long-term prevention of iron toxicity by well-designed randomized controlled trials.