Delayed spontaneous resolution of nephrotic syndrome in a patient with hepatitis C virus-associated membranoproliferative glomerulonephritis

Treatment with antiviral and/or immunosuppressive therapy is considered the standard care in patients with hepatitis C virus (HCV)-associated membranoproliferative glomerulonephritis (MPGN). However, even with an adequate therapy, a favourable response is not always guaranteed. In patients with HCV-associated MPGN, a delayed spontaneous remission of nephrotic syndrome is rare. We present here one such case. Our patient refused antiviral (and immunosuppressive) therapy throughout the course of his illness and was thus managed symptomatically. More than 8 months after presentation, an unexpected gradual resolution of his nephrotic syndrome was noted. The urine protein/creatinine ratio decreased from ~16 000 mg/g of creatinine on presentation to 500 mg/g of creatinine in the 12th month. This was however not accompanied by resolution of HCV or cryoglobulinaemic activity. Our case demonstrates the possibility of a delayed spontaneous remission occurring in this disease. This must be considered when weighing treatment options in such patients.