Clinicopathological Analysis and Therapy in Hepatitis C Virus-Associated Nephropathy.

Abstract

Weanalyzed the clinicopathological features and therapy in 19 patients with kidney disease accompanied by hepatitis C viral infection, including 12 patients with mesangial proliferative glomerulonephritis (including eight with IgA nephropathy), six with membranoproliferative glomerulonephritis (MPGN),and one with membranousnephropathy. Persistent hematuria and/ or proteinuria (10 patients) was the most commonfinding, followed by nephrotic syndrome (8 patients). Cryoglobulinemia was detected in six of 19 patients examined (four of six patients with MPGN).Analysis of hepatitis C virus (HCV)-RNAgenotype in 13 patients revealed that nine of them had type II genotype. All four patients with MPGN, who had serum positive for HCV-RNA, had type II genotype. Five patients were treated with interferon-a (IFN-a) without a demonstrable effect on renal impairment, whereas five of ll patients treated with steroids showed improvement of the renal impairment. During the course of steroid therapy, the serum titer of HCV-RNA decreased in 5 of7 patients. These observations suggest that HCVinfection may be associated with several forms ofglomerulonephritis. Type II HGV-RNA mayhave a strong association with MPGN in Japan. Steroid therapy is not contraindicated in patients with HCV-associated nephropathy if they are resistant to IFN-a treatment.

Membranoproliferative Glomerulonephritis and Leukocytoclastic Vasculitis without Cryoglobulin in Chronic Hepatitis C Virus Infection

“…Earlier introduction of interferon a and subsequent intensive immunosuppressive therapies including high-dose glucocorticoid, plasmapheresis, or immunosuppressive agents will likely achieve a better prognosis (4,7,10,20 …”

Hepatitis C virus-related glomerulonephritis with acute kidney injury requiring hemodialysis that improved with virus removal and eradication using double-filtration plasmapheresis without interferon

“…In a randomized controlled study, Dammacco et al [15] reported the use of corticosteroid therapy for type II mixed cryoglobulinemia. Komatsuda et al [16] reported that 5 of 11 patients treated with steroids showed improvement in renal impairment. In the present case, despite concerns about increased viral reproduction and risk of infection, corticosteroid therapy was administered for HCV-related glomerulonephritis to decrease cryoglobulinemia.…”

Antiviral Therapy for HCV-Associated Cryoglobulinemic Glomerulonephritis: Case Report and Review of the Literature

“…Review papers and case reports were excluded. Some manuscripts were excluded as they gave information on patients already reported in prior publications [10,11], others gave incomplete results [12,13,14,15,16,17,18]. …”