Skip to main content
Log in

Kidney disease in patients with chronic hepatitis c

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Amico G, Colasanti G, Ferrario F, Sinico RA: Renal involvement in essential mixed cryoglobulinemia. Kidney Int 1989, 35:1004–1014.

    PubMed  Google Scholar 

  2. Harle J, Disder P, Dussol B, et al.: Membranoproliferative glomerulonephritis and hepatitis C infection. Lancet 1993, 341:904.

    Article  PubMed  CAS  Google Scholar 

  3. Doutrelepont JM, Adler M, Willens M, Yap SH: Hepatitis C infection and membranoproliferative glomerulonephritis. Lancet 1993, 341:317.

    Article  PubMed  CAS  Google Scholar 

  4. Yamabe H, Johnson RJ, Gretch DR, et al.: Hepatitis C virus infection and membranoproliferative glomerulonephritis in Japan. J Am Soc Nephrol 1995, 6:220–223.

    PubMed  CAS  Google Scholar 

  5. Johnson RJ, Gretch DR, Yamabe H, et al.: Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. N Engl J Med 1993, 328:465–470.

    Article  PubMed  CAS  Google Scholar 

  6. Davda R, Peterson J, Weiner R, et al.: Membranous glomerulonephritis in association with hepatitis C virus infection. Am J Kidney Dis 1993, 22:452–455.

    PubMed  CAS  Google Scholar 

  7. Stehman-Breen C, Willson R, Alpers C, et al.: Hepatitis C virus associated membranous glomerulonephritis. Curr Opin Nephrol Hypertens 1995, 4:287–294.

    Article  PubMed  CAS  Google Scholar 

  8. Pol S, Thiers V, Carnot F, et al.: Efficacy and tolerance of alpha-2b interferon therapy on HCV infection of hemodialyzed patients. Kidney Int 1995, 47:1412–1418.

    PubMed  CAS  Google Scholar 

  9. Selby P, Kohn J, Raymond J, et al.: Nephrotic syndrome during treatment with interferon. Br Med J 1985, 290:1180.

    CAS  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.

    PubMed  CAS  Google Scholar 

  11. Coroneos E, Truong L, Olivero J: Fibrillary glomerulonephritis associated with hepatitis C viral infection. Am J Kidney Dis 1997, 29:132–135.

    PubMed  CAS  Google 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.

    PubMed  CAS  Google Scholar 

  13. Ferri C, Greco F, Longombardo G, et al.: Antibodies against hepatitis C virus in mixed cryoglobulinemia patients. Infection 1991, 19:417–420.

    Article  PubMed  CAS  Google Scholar 

  14. Ferri C, Greco F, Longombardo G, et al.: Hepatitis C virus antibodies in mixed cryoglobulinemia. Clin Exper Rheumatol 1991, 9:95–96.

    CAS  Google Scholar 

  15. Stokes MB, Chawla H, Brody RI, et al.: Immune complex glomerulonephritis in patients coinfected with human immunodeficiency virus and hepatitis C virus. Am J Kidney Dis 1997, 29:514–525.

    PubMed  CAS  Google Scholar 

  16. Morales E, Alegre R, Herrero JC, et al.: Hepatitis-C-virusassociated cryoglobulinaemic membranoproliferative glomerulonephritis in patients infected by HIV. Nephrol Dial Transplant 1997, 12:1980–1984.

    Article  PubMed  CAS  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.

    Article  PubMed  CAS  Google Scholar 

  18. Beaufils H, Jouanneau C, Katlama C, et al.: HIV-associated IgA nephropathy: a postmortem study. Nephrol Dial Transplant 1995, 10:35–38.

    PubMed  CAS  Google Scholar 

  19. Horikoshi S, Okada T, Shirato I, et al.: Diffuse proliferative glomerulonephritis with hepatitis C virus-like particles in paramesangial dense deposits in a patient with chronic hepatitis C virus hepatitis. Nephron 1993, 64:482–484.

    Article  Google 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.

    Article  PubMed  CAS  Google Scholar 

  21. Fornasieri A, Armelloni S, Bernasconi P, et al.: High binding of immunoglobulin M kappa rheumatoid factor from type II cryoglobulins to cellular fibronectin: a mechanism for induction of in situ immune complex glomerulonephritis? Am J Kidney Dis 1996, 27:476–483.

    PubMed  CAS  Google Scholar 

  22. Sansonno D, Gesualdo L, Manno C, et al.: Hepatitis C virus-related proteins in kidney tissue from hepatitis C virus-infected patients with cryoglobulinemic membranoproliferative glomerulonephritis. Hepatology 1997, 25:1237–1244.

    Article  PubMed  CAS  Google Scholar 

  23. Misiani R, Bellavita P, Fenili D, et al.: Interferon alfa-2a therapy in cryoglobulinemia associated with hepatitis C virus. N Engl J Med 1994, 330:751–756.

    Article  PubMed  CAS  Google Scholar 

  24. Sarac E, Bastacky S, Johnson JP: Response to high-dose alfa interferon after failure of standard therapy in MPGN associated with HCV infection. Am J Kidney Dis 1997, 30:113–115.

    PubMed  CAS  Google Scholar 

  25. Johnson RJ, Gretch DR, Couser WG, et al.: Hepatitis C virusassociated glomerulonephritis.: effect of alpha-interferon therapy. Kidney Int 1994, 46:1700–1704.

    PubMed  CAS  Google Scholar 

  26. Morosetti M, Sciarra G, Meloni C, et al.: Membranoproliferative glomerulonephritis and hepatitis C: effects of interferon-alpha therapy on clinical outcome and histological pattern. Nephrol Dial Transplant 1996, 11:532–534.

    PubMed  CAS  Google Scholar 

  27. Polynard T, Leroy V, Cohard M, et al.: Meta-analysis of interferon randomized trials in the treatment of viral hepatitis C: effects of dose and duration. Hepatology 1996, 24:778–789.

    Article  Google 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.

    PubMed  CAS  Google 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.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Philipneri, M., Bastani, B. Kidney disease in patients with chronic hepatitis c. Curr Gastroenterol Rep 3, 79–83 (2001). https://doi.org/10.1007/s11894-001-0045-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-001-0045-0

Keywords

Navigation