For membranoproliferative GN associated with hepatitis C, which antiviral regimen is indicated?

• A. Prednisone
• B. Cyclophosphamide
• C. Interferon and ribavirin
• D. Rituximab

Answer: (C)

Membranoproliferative GN in the setting of hepatitis C is driven by ongoing HCV infection and associated cryoglobulinemia. The kidney injury improves when the underlying viral antigenic stimulus is removed, so the treatment should target the virus itself. The combination of interferon and ribavirin directly suppresses HCV replication, reduces production of cryoglobulins, and decreases immune complex–mediated glomerular inflammation. As the viral load falls, the immune-driven injury in the glomeruli subsides and renal function can improve. Immunosuppressive approaches like prednisone or cyclophosphamide don’t address the root cause and can increase infection risk, while rituximab may be considered in refractory cases but is not the primary antiviral strategy. Thus, treating the hepatitis C infection with interferon and ribavirin is the most appropriate first-line approach for this scenario.