Kidney disease in patients with chronic hepatitis c
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There is an increasing recognition of the association between chronic hepatitis C virus infection and glomerular diseases. Renal complications may be the presenting manifestation of hepatitis C virus infection. Patients may present with signs and symptoms of cryoglobulinemic systemic vasculitis, proteinuria, microscopic hematuria, acute renal failure, or nephrotic syndrome. The pathogenesis of hepatitis C virus associated with renal disease remains incompletely understood; however, deposition of circulating immune complexes in the subendothelial space and mesangium in the glomeruli seems to play a major role. The most common renal pathology associated with hepatitis C virus infection is type I membranoproliferative glomerulonephritis with or without cryoglobulinemia. In patents who do not have significant renal impairment, combination therapy with interferon alfa (IFN-α) and ribavirin seems to be the treatment of choice, although the experience with this combination is quite limited in patients with renal involvement. A prolonged course of high-dose IFN-α has been most commonly used for these patients with significant success, but relapse of hepatitis C viremia and renal disease after discontinuation of therapy have frequently occurred.
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References and Recommended Reading
- 9.Selby P, Kohn J, Raymond J, et al.: Nephrotic syndrome during treatment with interferon. Br Med J 1985, 290:1180.Google Scholar
- 10.Usalan C, Erdem Y, Altun B, et al.: Rapidly progressive glomerulonephritis associated with hepatitis C virus infection. Clin Nephrol 1998, 49:129–131. A case report of a 20-year-old woman who developed rapidly progressive glomerulonephritis during the course of active HCV infection. Whether this is a true association or a coincidental finding is unknown.PubMedGoogle Scholar
- 12.Markowitz GS, Cheng JT, Colvin RB, et al.: Hepatitis C viral infection is associated with fibrillary glomerulonephritis and immunotactoid glomerulopathy. J Am Soc Nephrol 1998, 9:2244–2252. Report of four cases of fibrillary glomerulonephritis and two cases of immunotactoid glomerulopathy in association with HCV infection. Outcomes were variable.PubMedGoogle Scholar
- 14.Ferri C, Greco F, Longombardo G, et al.: Hepatitis C virus antibodies in mixed cryoglobulinemia. Clin Exper Rheumatol 1991, 9:95–96.Google Scholar
- 17.Rivera M, Gonzalo A, Maqmpaso, et al.: The heterogeneity of glomerulonephritis associated with HIV. Nephrol Dial Transplant 1999, 14:244–245. Report of four patients with HCV/HIV co-infection who were noted to have the following renal histopathologies: membranous nephropathy in two patients, focal segmental glomerulosclerosis in one, and diffuse proliferative glomerulonephritis in the other.PubMedCrossRefGoogle Scholar
- 20.Pucillo L, Agnello V: Membranoproliferative glomerulonephritis associated with hepatitis B and C viral infections: from virus-like particles in the cryoprecipitate to viral localization in paramesangial deposits, problematic investigations prone to artifacts. Curr Opin Nephrol Hypertens 1994, 3:465–470.PubMedCrossRefGoogle Scholar
- 28.Baid S, Pascual M, Williams W, et al.: Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C-positive renal allograft receipients. J Am Soc Nephrol 1999, 10:146–153. According to this report, all five patients (out of 18 recipients of HCVpositive serology pretransplant) with biopsy-proven de novo renal thrombotic microangiopathy (RTMA) had a positive ACA test, compared with only one of 13 patients without RTMA. The occurrence of this condition may reflect unfavorable outcome for patient and graft survival.PubMedGoogle Scholar
- 29.Legendre CH, Garrigue V, Le Bihan C, et al.: Harmful long-term impact of hepatitis C virus infection in kidney transplant receipients. Transplantation 1998, 65:667–670. Report on a retrospective study from France comparing patient survival and cause of death among anti-HCV-positive (n=387) and - negative (n=112) transplant recipients. Anti-HCV-positive patients had significantly shorter patient and graft long-term survival than anti-HCV-negative patients. Increased mortality was primarily due to liver disease and sepsis.PubMedCrossRefGoogle Scholar