Interferons can cause bone marrow suppression that may result in declines in all three blood cell lines. Ribavirin can cause a hemolytic anemia. The traditional approach to hematologic toxicity has been reducing the dose of the offending antiviral; however, lower doses also may reduce treatment efficacy. 16 The use of epoetin alfa (Epogen) at a dose of 40,000 units subcutaneously once per week is effective in increasing the hematocrit level in patients receiving treatment and in reducing the number of patients who require reductions or discontinuations of their ribavirin. 18 If anemia becomes a problem, an attempt should be made to use epoetin alfa before reducing the ribavirin dosage below 800 mg a day. 16 , 19 Special caution should be used for patients with cardiac disease. Most of the drop in hematocrit typically occurs in the first month, with the nadir occurring somewhere between weeks 8 and 24 of therapy.
The presence of protein in urine is a common laboratory finding in children. Although proteinuria is usually benign, it can be a marker of a serious underlying renal disease or systemic disorder. 1 – 3 When proteinuria coexists with hematuria, the likelihood of clinically significant renal disease is higher. 1 , 2 Further, proteinuria represents an independent risk factor for the progression of nonglomerular or glomerular chronic kidney disease in children. 4 – 9 The Chronic Kidney Disease in Children study demonstrated that persistent proteinuria with a high urine protein-to-creatinine (UPr/Cr) ratio (more than 2 in patients with nonglomerular disease and more than in patients with glomerular disease) predicts significant chronic kidney disease progression. 7 The challenge for the primary care physician is to separate benign forms of proteinuria from those with clinical significance.
Negotiations for a 6 December rematch began.  After negotiations collapsed, Vitali defeated Kirk Johnson in a WBC Eliminator bout on 6 December date,  setting up a mandatory rematch with Lewis. In January 2004, the WBC announced that it would strip Lewis of the belt if he let pass a 15 March deadline to sign for a rematch with Vitali.  Shortly thereafter, Lewis announced his retirement and vacated the title. For years after this fight, Klitschko would still occasionally call out Lewis, despite the fact that Lewis has been retired since early 2004, for a rematch.