We describe a treatment made with interferon-alpha (IFN-alpha) plus ribavirin of two patients with membranoproliferative glomerulonephritis (MPGN) induced by hepatitis C virus (HCV): Case 1 was a 22-year-old woman with leg and facial edema, hypertension and proteinuria, whose liver biopsy revealed chronic active hepatitis; and Case 2 was a 42-year-old man with anasarca, hypertension and proteinuria, whose liver biopsy indicated cirrhosis. Both had anti-HCV, HCV-RNA and cryoglobulins. IFN-alpha (3 million units (MU), 3 times/week) and ribavirin (1 g/day) were administered for 12 months. The drugs were well tolerated by both patients. Serum alanine aminotransferase (ALT) levels normalized and HCV-RNA became negative. Cryoglobulins disappeared and an improvement in renal disease was seen after 6 months of therapy. However, after 9 months, Case 2 presented ALT elevation, and proteinuria was detected. Two years after the end of therapy, both patients were negative in repeated HCV-RNA and cryoglobulin tests. Case 1 was asymptomatic, with normal liver and renal tests, and Case 2 had normal blood pressure, with mild edema of the ankles. Based on the evolution of these two cases, the association of IFN-alpha and ribavirin may be a therapeutic option for patients with MPGN related to HCV.

After offering a panoramic view of the articles related to Fundamental Theology (issues related to the Revelation, faith and the interpretation of the Scriptures; matters of theological method; reception and elaboration of reflections about our times, and fundamental Theology Projects) published by the Journal, the study focuses on the work of two Fundamental Theology lecturers at the Faculty: Antonio Bentué and Sergio Silva. The analysis considers the way in which their theologies adjust to modernity and its challenges, the reception they make of the Magisterial and the Latin American Theology, and the implications of this dialogue with time and place regarding the method and the Theological work. The final critical perspectives, inspired in the philosophy by Paul Ricoeur, set emphasis on the continuity, where the authors mentioned above have stressed the discontinuity. In order to avoid dualist and pessimist temptations, the article gives an example of articulation between the level of the facts and the level of the sense in the analysis of freedom. It also shows how the theonomy may integrate the modern autonomy. According to the Fundamental theology of our author, the final reflection shows that modern condition of faith is to believe ‘in conscience’.

Después de ofrecer una visión panorámica de los artículos publicados por la revista, que se ocupan de cuestiones de teología fundamental (cuestiones de revelación y fe y de interpretación de la escritura; cuestiones de método teológico; recepción y elaboración de reflexiones sobre nuestro tiempo y sobre proyectos teológicos fundamentales), la indagación se centra en los trabajos de dos profesores de teología fundamental de la facultad: Antonio Bentué y Sergio Silva. El análisis considera el modo como sus teologías se hacen cargo del tiempo presente y los desafíos que plantea la modernidad, la recepción que hacen del magisterio y la teología latinoamericana y las implicaciones que respecto del método y quehacer teológicos tiene este diálogo con el tiempo y el lugar. Las perspectivas críticas finales, inspiradas en la filosofía de Paul Ricoeur, pretenden poner el énfasis en la continuidad allí donde los autores estudiados han subrayado la discontinuidad. Con el objeto de evitar las tentaciones dualistas y pesimistas se ofrece en el análisis de la libertad un ejemplo de articulación entre el nivel de los hechos y el nivel del sentido y se muestra cómo la teonomía puede integrar la autonomía moderna. En continuidad con la teología fundamental de nuestros profesores, una reflexión final muestra que creer "en conciencia" es la condición moderna de la fe.

Descrevem-se pacientes com glomerulonefrites (GNs) associadas à infecção pelo vírus da hepatite C (HCV). Entre agosto de 93 e julho de 96 foram observados 4 pacientes, com idade mediana de 41 anos, sendo 2 do sexo masculino. Pesquisaram-se o anti-HCV por ensaio imuno-enzimático e o HCV-RNA por PCR. Também foram pesquisadas crioglobulinas séricas, hemácias dismórficas no sedimento urinário e proteinúria de 24h. Viremia, crioglobulinas, hematúria e proteinúria foram observadas nos 4 pacientes. As biópsias hepáticas revelaram atividade inflamatória nos 3 pacientes em que foram realizadas e as do rim revelaram glomerulonefrite membranoproliferativa em 3 e glomerulonefrite proliferativa mesangial em 1 paciente. Dois pacientes vêm recebendo antivirais (IFN associado à ribavirina) e evoluindo com melhora. A presença de viremia e de hepatite concomitante com as alterações urinárias constituem indícios do envolvimento viral na glomerulopatia. Tais achados são reforçados pela melhora das alterações urinárias durante o tratamento específico. Conclui-se que a pesquisa de marcadores virais em pacientes com GNs assume relevância na medida em que pode modificar a conduta terapêutica.

We report 4 patients with glomerulonephritis (GN) associated with hepatitis C virus (HCV) infection seen between August 1993 and July 1996. Two of them were male and median age was 41 years. Anti-HCV was detected by enzyme-immunoassay and HCV-RNA by PCR. Serum cryoglobulins, 24-hour proteinuria, and erythrocyte dismorphism were also determined. Viremia, cryoglobulinemia, hematuria and proteinuria were observed in all patients. Liver biopsies revealed inflammatory activity in 3 cases, and renal biopsies revealed membranoproliferative glomerulonephritis in 3 patients and mesangial proliferative glomerulonephritis in 1 patient. Two patients are on specific therapy for HCV infection (IFN in combination with ribavirin) and have presented clinical and laboratory improvement. The occurrence of active liver disease and viremia concurrent with urinary alterations suggests viral involvement in renal disease, a conclusion supported by the by improvement of urinary alterations observed after treatment for HCV. We conclude that the search for viral markers in patients with GN is important since their detection could change the therapeutic approach.

Este estudo teve como objetivo avaliar a presença de auto-anticorpos em pacientes com hepatite crônica pelos vírus B e C, antes, durante e após tratamento com interferon-alfa (IFN-alfa), assim como estudar a relação destes anticorpos com o tipo de IFN, com a dose e com a resposta terapêutica. Cinqüenta pacientes com hepatite viral crônica foram divididos em 2 grupos: grupo-controle constituído por 21 pacientes (10 hepatites B e 11 hepatites C), que foram seguidos durante 6 meses sem tratamento e grupo-IFN constituído por 29 pacientes (8 hepatites B e 21 hepatites C), que receberam IFN-alfa durante 6 meses. Anticorpos antinúcleo, antimúsculo liso, antimitocôndria, anticélula parietal e antitireóide foram pesquisados em amostras de soro colhidas antes do início, durante e ao final do estudo. Quatro dos 50 pacientes (8%) apresentavam auto-anticorpos no início do estudo (2 em cada grupo). Durante o estudo nenhum paciente do grupo-controle desenvolveu auto-anticorpos, enquanto que 3 (11%) pacientes do grupo-IFN passaram a apresentá-los. Os auto-anticorpos ocorreram apenas em pacientes tratados com doses mais elevadas de IFN. Verificou-se ainda tendência à resposta desfavorável ao tratamento naqueles indivíduos que apresentaram ou desenvolveram auto-anticorpos. Assim, sugere-se que mais estudos sejam realizados para determinar se existe ou não relação entre resposta desfavorável e a presença ou o desenvolvimento de auto-anticorpos.

This study was undertaken to investigate the presence of autoantibodies in patients with chronic viral hepatitis B and C, before, during and after interferon-alpha (IFN-alpha) therapy and to study their relation to dose and type of IFN-alpha and response to treatment. Fifty patients with chronic hepatitis were divided in two groups, a control-group of 21 patients (10 type B and 11 type C) who were followed for 6 months without treatment and an IFN-group consisting of 29 patients (8 type B and 21 type C) who received IFN therapy for 6 months. Serum samples were tested for a range of antibodies at the start of the study, during therapy and at the end of the 6 month period. Antibodies tested for included: antinuclear, smooth muscle, antimitochondrial, parietal cell and thyroid microsomal. Four (8%) of the total patient group had autoantibodies at the beginning of the study (two in each group). During the follow-up period no patient in the control group developed antibodies compared with 3 (11%) patients in the treatment group. Autoantibodies developed in patients treated with higher doses of IFN and were found in those patients who tended to show a poor response to IFN-therapy. Further studies are needed to establish the relationship between poor response to IFN-alpha and development of autoantibodies.