Community Minded

How to treat RPGN with HCV? 
A 48-year-old presents with rapidly progressive glomerulonephritis (RPGN) requiring dialysis and is found to have hepatitis C (HCV) with a high viral load. Serum complements are low, and the rheumatoid factor is positive. A renal biopsy shows a crescentic glomerulonephritis with immunoglobulin M (IgM) dominance. While cryoglobulins are pending, do you begin plasmapheresis followed by rituximab? Or is hepatitis C anti-viral therapy alone enough? What therapies are best and when should you start and end them? Share your thoughts.

Summary provided by Roger Rodby, MD, FASN.
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