Mixed cryoglobulinemic syndrome, which is a
systemic vasculitis characterized by the
immune complex deposition in small- and medium-sized arteries and most often due to
chronic hepatitis C virus (HCV)
infection, sometimes clinically manifests as refractory
glomerulonephritis or nephritic syndrome. Patients with mixed cryoglobulinemic nephropathy who have a rapidly progressive
glomerulonephritis should receive immunosuppressive therapy. After disease stabilization, patients should receive concurrent
therapy for the underlying HCV
infection. The standard
therapy of a chronic HCV
infection is IFN monotherapy or IFN combined with
ribavirin; however, after the introduction of direct-acting
antivirals (DAAs), the standard
therapy for patients with HCV genotype 1 has dramatically changed. We report a case of HCV-associated cryoglobulinemic
membranoproliferative glomerulonephritis (MPGN) successfully treated by
daclatasvir and
asunaprevir, which are IFN-free DAAs for HCV, in combination with
angiotensin II receptor blocker without immunosuppressive therapy. The patient developed severe
nephrotic syndrome with progressive kidney dysfunction. Blood examination revealed a high copy number of HCV-
RNA (6.4 log IU/mL, type 1),
cryoglobulinemia,
paraproteinemia of
IgM-κ, and hypocomplementemia. Histological analysis showed MPGN type 1. These findings were compatible with those observed in HCV-associated cryoglobulinemic MPGN. This case offers original evidence for the application of newer generation of IFN-free DAAs in the treatment of HCV-associated cryoglobulinemic nephropathy.