Hepatitis C virus infection and glomerular disease

Minerva Urol Nefrol. 2014 Jun;66(2):139-49.

Abstract

The association between hepatitis C virus (HCV) infection and chronic kidney disease (CKD) is well established and remains an area of intense research. HCV infection is associated with a large spectrum of histo-pathological lesions in both native and transplanted kidneys. The frequency of kidney damage in HCV-infected patients appears low even if is not fully detailed. The most frequent HCV-associated renal lesion is type I membrano-proliferative glomerulonephritis, usually in the context of type II mixed cryoglobulinemia. Various approaches have been tried for the treatment of HCV-related glomerulonephritis, including immunosuppressive therapy (corticosteroids and cytotoxic agents), plasma exchange and antiviral agents. Antiviral treatment of HCV-associated glomerulonephritis has shown encouraging results. Immunosuppressive therapy is particularly recommended for cryoglobulinemic kidney disease. Two distinct approaches should be considered for the treatment of HCV-associated cryoglobulinemic glomerulonephritis according to the level of proteinuria and kidney failure. Some evidence on rituximab therapy for HCV-related cryoglobulinemic glomerulonephritis exists but several questions related to its use need to be addressed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antiviral Agents / therapeutic use
  • Clinical Trials as Topic
  • Cryoglobulinemia / drug therapy
  • Cryoglobulinemia / etiology
  • Cryoglobulinemia / virology
  • Glomerular Filtration Rate
  • Glomerulonephritis, Membranoproliferative / etiology
  • Hematuria / etiology
  • Hepacivirus / genetics
  • Hepacivirus / isolation & purification
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / drug therapy
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Interferons / therapeutic use
  • Kidney Transplantation
  • Nephritis, Interstitial / etiology
  • Postoperative Complications / virology
  • Proteinuria / etiology
  • RNA, Viral / blood
  • Renal Insufficiency, Chronic / etiology*
  • Rituximab
  • Viremia / complications

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal, Murine-Derived
  • Antiviral Agents
  • Immunosuppressive Agents
  • RNA, Viral
  • Rituximab
  • Interferons