Sabry Alaa A, Sobh Mohamed A, Sheaashaa Hussein A, Kudesia Guara, Wild Graham, Fox Samantha, Wagner Bart E, Irving William L, Grabowska Anna, El-Nahas Abdel Meguid
Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Nephrol Dial Transplant. 2002 Nov;17(11):1924-30. doi: 10.1093/ndt/17.11.1924.
Hepatitis C virus (HCV) is a major cause of acute and chronic hepatitis throughout the world. Several extrahepatic manifestations, including glomerulonephritis, have been reported to be associated with this type of infection. Cryoglobulinaemic and non-cryoglobulinaemic membranoproliferative glomerulonephritis (MPGN) and membranous nephropathy (MN) are the commonest lesions associated with HCV. Results of treatment of these patients with interferon therapy have been disappointing, since relapse of the viraemia and subsequent relapse of the renal disease are major problems. Combination of interferon with ribavirin in patients with chronic liver disease has been shown to increase the rate of sustained response.
In this work, 20 patients with HCV-associated glomerulopathy were subjected to an in-depth evaluation of their kidney lesions and HCV involvement. Laboratory, histopathological, immunohistochemical, and electron-microscopy techniques were used. The patients received interferon therapy for 12 months; in interferon-resistant subjects, interferon was combined with ribavirin.
MPGN was the commonest kidney lesion, being reported in 85% of these cases, followed by MN and mesangioproliferative glomerulonephritis (10 and 5% respectively). Mixed cryoglobulinaemia was encountered in 60% of the cases. Twelve months' anti-viral treatment resulted in aviraemia in 25% of cases, while liver enzymes were normalized in 75%, 24-h proteinuria significantly decreased (from median 4 g to 1.10 g, P=0.001), serum albumin increased (from median 2.50 to 3.55 g/dl, P=0.012), lower viral titres (from median 1.15 to 0.53 mega-Eq/ml, P=0.049), and C3 and C4 concentrations returned to normal. Basal serum creatinine and viral titres were important determinants of response to treatment.
This study supports the relationship between HCV and glomerulonephritis, especially MPGN, and the use of a combination of interferon and ribavirin in the treatment of selected cases of HCV-related glomerulopathy.
丙型肝炎病毒（HCV）是全球急性和慢性肝炎的主要病因。据报道，包括肾小球肾炎在内的几种肝外表现与这种感染类型有关。冷球蛋白血症性和非冷球蛋白血症性膜增生性肾小球肾炎（MPGN）以及膜性肾病（MN）是与HCV相关的最常见病变。用干扰素治疗这些患者的结果令人失望，因为病毒血症复发和随后的肾脏疾病复发是主要问题。在慢性肝病患者中，干扰素与利巴韦林联合使用已显示可提高持续应答率。
在这项研究中，对20例HCV相关性肾小球病患者的肾脏病变和HCV累及情况进行了深入评估。采用了实验室、组织病理学、免疫组织化学和电子显微镜技术。患者接受了12个月的干扰素治疗；对干扰素耐药的患者，将干扰素与利巴韦林联合使用。
MPGN是最常见的肾脏病变，在这些病例中有85%的报告，其次是MN和系膜增生性肾小球肾炎（分别为10%和5%）。60%的病例出现混合性冷球蛋白血症。12个月的抗病毒治疗使25%的病例出现病毒血症消失，同时75%的患者肝酶恢复正常，24小时蛋白尿显著降低（从中位数4g降至1.10g，P = 0.001），血清白蛋白增加（从中位数2.50g/dl升至3.55g/dl，P = 0.012），病毒滴度降低（从中位数1.15百万当量/毫升降至0.53百万当量/毫升，P = 0.049），C3和C4浓度恢复正常。基础血清肌酐和病毒滴度是治疗反应的重要决定因素。
本研究支持HCV与肾小球肾炎之间的关系，尤其是MPGN，以及干扰素和利巴韦林联合用于治疗部分HCV相关性肾小球病病例。
