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Original ArticlesClinical Nephrology
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Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis

Glen S. Markowitz, Samih H. Nasr, M. Barry Stokes and Vivette D. D'Agati
CJASN April 2010, 5 (4) 607-615; DOI: https://doi.org/10.2215/CJN.07311009
Glen S. Markowitz
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Samih H. Nasr
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M. Barry Stokes
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Vivette D. D'Agati
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This article has a correction. Please see:

  • Erratum - July 01, 2010

Abstract

Background and objectives: Treatment with IFN is rarely associated with nephrotic syndrome and renal biopsy findings of minimal-change disease or FSGS.

Design, setting, participants, & measurements: We report 11 cases of collapsing FSGS that developed during treatment with IFN and improved after discontinuation of therapy.

Results: The cohort consists of seven women and four men with a mean age of 48.2 yr. Ten of the 11 patients were black. Six patients were receiving IFN-α for hepatitis C virus infection (n = 5) or malignant melanoma (n = 1), three were receiving IFN-β for multiple sclerosis, and two were treated with IFN-γ for idiopathic pulmonary fibrosis. After a mean and median duration of therapy of 4.0 and 12.6 months, respectively, patients presented with acute renal failure (mean creatinine 3.5 mg/dl) and nephrotic-range proteinuria (mean 24-hour urine protein 9.7 g). Renal biopsy revealed collapsing FSGS with extensive foot process effacement and many endothelial tubuloreticular inclusions. Follow-up was available for 10 patients, all of whom discontinued IFN. At a mean of 23.6 months, nine of 10 patients had improvement in renal function, including one with complete remission and two with partial remission. Among the seven patients with available data, mean proteinuria declined from 9.9 to 3.0 g/d. Four of the seven patients were treated with immunosuppression, and there was no detectable benefit.

Conclusions: Collapsing FSGS may occur after treatment with IFN-α, -β, or -γ and is typically accompanied by the ultrastructural finding of endothelial tubuloreticular inclusions. Optimal therapy includes discontinuation of IFN.

Footnotes

    • Received October 14, 2009.
    • Accepted January 24, 2010.
    • Copyright © 2010 by the American Society of Nephrology
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    Clinical Journal of the American Society of Nephrology
    Vol. 5, Issue 4
    1 Apr 2010
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    Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis
    Glen S. Markowitz, Samih H. Nasr, M. Barry Stokes, Vivette D. D'Agati
    CJASN Apr 2010, 5 (4) 607-615; DOI: 10.2215/CJN.07311009

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    Treatment with IFN-α, -β, or -γ Is Associated with Collapsing Focal Segmental Glomerulosclerosis
    Glen S. Markowitz, Samih H. Nasr, M. Barry Stokes, Vivette D. D'Agati
    CJASN Apr 2010, 5 (4) 607-615; DOI: 10.2215/CJN.07311009
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