Recurrent membranous nephropathy and acute cellular rejection in a patient treated with direct anti‐HCV therapy (ledipasvir/sofosbuvir)

Abstract

Direct-acting antiviral agents (DAAs) are very effective therapy for chronic hepatitis C infection, and have revolutionized the treatment of hepatitis C in kidney allograft recipients. Although well tolerated in general, rare renal complications have been reported. We describe a case of recurrent membranous nephropathy and acute cellular rejection in a kidney allograft recipient after DAA (ledipasvir/sofosbuvir) therapy, whose allograft function had been stable for more than 30 years. The patient was presented with nephrotic range proteinuria with stable creatinine. The kidney allograft biopsy revealed recurrent membranous nephropathy with fine granular deposits of IgG1/IgG4 codominance and positive phospholipase A2 receptor (PLA2R) staining. The patient was treated with pulse steroid and rituximab, leading to a decrease in proteinuria. As DAAs are more frequently used, physicians should be aware of immune-related renal complications.

Traditional Chinese Medicine in Treating Primary Podocytosis: From Fundamental Science to Clinical Research

“…Pathological changes in MN ( Murakami et al, 2018 ), FSGS ( Hogan et al, 2017 ), and lupus-like nephritis ( Sise et al, 2016 ) occurred in patients with chronic hepatitis C infection after receiving direct-acting antivirals (including ribavirin, simeprevir, sofosbuvir, and ledipasvir). Kidney damage from such drugs may include direct podocyte toxicity and immune complex deposition.…”

Immunomodulatory Effects of Cholera Toxin B Subunit and Peptide LKEKK

“…Pusey CD, et al [31]recommended TPE for severe cases of immune complex nephritis (Table 1). Besides TPE, Immunoadsorption, monoclonal human antibodies such as rituximab are used successfully in ICN [32,33].…”