Hepatitis C Infection and Chronic Renal Diseases

Abstract

More than 170 million people worldwide are chronically infected with the hepatitis C virus (HCV), which is responsible for over 1 million deaths resulting from cirrhosis and liver cancers. Extrahepatic manifestations are also relevant and include mixed cryoglobulinemia, lymphoproliferative disorders, and kidney disease. HCV infection is both a cause and a complication of chronic kidney disease, occurring largely in the context of mixed cryoglobulinemia. This infection also represents a major medical and epidemiologic challenge in patients with end-stage renal disease on renal replacement therapy with dialysis or transplantation. In these settings the presence of HCV correlates with higher rates of patient mortality than in HCV-negative subjects on dialysis or undergoing kidney transplant. The major concern is the lack of safe and effective drugs to treat HCV-infected patients with chronic kidney disease. Unfortunately, there are no large-scale clinical trials in this population, especially those receiving renal replacement therapy, so that strong evidence for treatment recommendations is scant. This review article provides the readers with the most recent insights on HCV infection both as cause and complication of chronic kidney disease, discusses pitfalls and limitations of current therapies, and reports on preliminary experience with novel therapeutic agents, as well as directions for future research.

Hepatitis C virus genotypes in hemodialysis patients in the Federal District, Brazil

“…These patients have an increased tendency to become HCV chronic carriers and also to be a potential reservoir for its transmission, possibly contributing to the nosocomial spread of HCV in dialysis centers 5,13 . In addition, hepatitis C seems to increase the mortality rate in this group of patients 4,20 .…”

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 previous study, a SVR was achieved in only 30-50 % of patients with genotype 1 receiving IFNa and ribavirin, but in 65-90 % of those with genotype 2 or 3 [3]. Unfortunately, our patient was infected with viral genotype 1 and had a high viral load, both of which are associated with resistance to IFN therapy [11].…”

“…However, published case reports and uncontrolled studies have only included a small number of patients, and the results have been controversial [3]. In a recent Japanese study [4], double-filtration plasmapheresis (DFPP) was used as antiviral treatment with IFN and ribavirin for chronic hepatitis C patients, and significantly higher reductions in viral load and better sustained virological response (SVR) rates were achieved compared with a non-DFPP group.…”

Hepatitis C Virus Associated Glomerulonephritis

“…Circulating immune complexes, including cryoglobulins, deposit in glomeruli along the capillary walls and in the mesangium. IgM kappa rheumatoid factor has a particular affinity for cellular fibronectin in the mesangial matrix (Perico et al, 2009). While immunoglobulins are readily and routinely identified in glomerular tissues, the demonstration of HCV antigens in glomeruli is controversial and limited to relatively small numbers of studies.…”