Renal pathology in HCV infected patients - Report of 148 patients and review of the literature

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Abstract

Background: Hepatitis C virus infection (HCV) is a major public health problem with a reported incidence of 3-4 million cases per year. Renal injury secondary to HCV was initially observed in autopsy studies and later in kidney biopsies. Several types of renal disease have been recognized in association with HCV patients. Objectives: Characterize the type of renal disease found in HCV-infected patients and established as possible relation with clinical presentation. Methods: Unicentric retrospective study of HCV patients with a renal biopsy from January 1988 to December 2015. The clinical data at biopsy time was analyzed according to histological diagnosis. Results: HCV infection was present in 148 cases. Male gender was predominant (76.7%), as was Caucasian race (79.1%). Mean age was 41.46±11.47years. Histological study of renal biopsies revealed membranoproliferative glomerulonephritis (MPGN) type 1 to be the commonest lesion encountered (37.2%), followed by proliferative glomerulonephritis (16.9%), focal segmental glomerulosclerosis (FSGS) (10.1%), and tubulointerstitial nephropathy (10.1%). Other patterns (amyloidosis, diabetic nephropathy, membranous nephropathy, IgA nephropathy) were observed. Hypocomplementaemia and cryoglobulinaemia showed correlation with MPGN diagnosis. A statistically significant correlation was observed with human immunodeficiency virus (HIV) infection and FSGS diagnosis. Amyloidosis diagnosis was associated with advanced age. No other significant correlations were found. Conclusions: Renal disease in HCV patients has a broad spectrum. No strong correlations between clinical data and pattern of renal disease have been established and it seems that is not possible to predict the renal disease based on clinical criteria alone. Renal biopsy remains the gold standard for diagnosis.

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Global challenges in liver disease.

Roger Williams (2006)

Immigration, cheap air travel, and globalization are all factors contributing to a worldwide spread of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. End-stage chronic liver disease (ESLD) as a result of co-infection with HBV/HCV is now the major cause of death for individuals who have been infected with the HIV virus. The high incidence of HCV infection in Egypt--the legacy left from the mass use of tartar emetic to eradicate schistosomiasis, as in other high prevalence areas--will take years to reduce. Steatohepatitis due to non-alcoholic fatty liver disease is developing into a new and major health problem as a result of rising levels of obesity in populations worldwide. Hepatic steatosis also has an adverse influence on the progression of other liver diseases including chronic HCV infection and alcoholic liver disease. In many countries, considerable public concern is on the rise due to increased levels of alcohol consumption adversely affecting younger and affluent age groups. With the rising prevalence of cirrhosis, primary hepatocellular carcinoma (HCC) is increasing in frequency as is that of primary intrahepatic cholangiocarcinoma. Finally, despite the successes of liver transplantation, many deserving patients are not getting transplants due to low levels of cadaver organ donation in many countries, thereby increasing pressures on the use of living donor liver transplantation. Only through a concerted effort from governments, health agencies, healthcare professionals at all levels, and the pharmaceutical industry can this grim outlook for liver disease worldwide be reversed.