Kes Petar, Slavicek Jasna
Department of Dialysis, Zagreb University Hospital Center, Zagreb, Croatia.
Acta Med Croatica. 2009 Dec;63(5):431-6.
Soon upon its discovery, hepatitis C virus (HCV) was recognized as an important cause and consequence of chronic kidney disease (CKD). HCV is a significant cause of some forms of glomerulonephritis (GN), especially membranoproliferative GN (MPGN). Subsequent population-based studies found an association between HCV positivity and CKD markers such as albuminuria or proteinuria. HCV infection is a frequent sequel of CKD. Blood transfusions (before effective screening of blood donors for HCV was instituted), nosocomial transmission in dialysis units, and transmission by kidney grafts all have contributed to the much higher prevalence of HCV infection in end-stage renal disease (ESRD) and transplant patients as compared to the general population. The current prevalence of HCV in dialysis centers is between 5% and 10% in European Union, and around 8.4% in Croatia. Strict adherence to 'universal precautions', careful attention to hygiene and strict sterilization of dialysis machines is recommended. The prevalence of HCV infection in CKD transplant patients is also high. Consistent risk factors include total time spent on dialysis and a history and/or number of blood transfusions, yet paralleling the prevalence in the general population of the same country or region. Patients with CKD who are considered for treatment should have virologic evidence of chronic HCV infection (i.e. HCV RNA detectable in serum). Treating chronic HCV infection in CKD patients is associated with a number of challenges. As the glomerular filtration rate (GFR) decreases, the half-life of both interferons (IFNs) (standard and pegylated) and ribavirin increases, resulting in a potentially poorer tolerance and the need for dosage adaptations in severe CKD. In kidney graft recipients, the use of IFNs and immunostimulants further entails a substantial risk of rejection. IFN therapy in hemodialysis patients results in good biochemical and virologic response and appears to exert a beneficial effect on the course of liver disease following renal transplantation. IFN-alpha therapy for the treatment of HCV-infected ESRD patients on maintenance dialysis, administered prior to renal transplantation, is associated with high rates of sustained biochemical and virologic response in the post-transplant period. Thus, IFN-alpha therapy seems to be advisable for HCV-infected dialysis patients that are candidates for renal transplantation.
丙型肝炎病毒（HCV）在被发现后不久，就被确认为慢性肾脏病（CKD）的一个重要病因及后果。HCV是某些形式的肾小球肾炎（GN）的重要病因，尤其是膜增生性肾小球肾炎（MPGN）。随后基于人群的研究发现HCV阳性与CKD标志物如白蛋白尿或蛋白尿之间存在关联。HCV感染是CKD的常见后果。输血（在对献血者进行有效的HCV筛查之前）、透析单位的医院内传播以及肾移植传播，都导致了与普通人群相比，终末期肾病（ESRD）患者和移植患者中HCV感染的患病率要高得多。目前在欧盟，透析中心HCV的患病率在5%至10%之间，在克罗地亚约为8.4%。建议严格遵守“普遍预防措施”，仔细注意卫生并对透析机进行严格消毒。CKD移植患者中HCV感染的患病率也很高。一致的危险因素包括透析总时长以及输血史和/或输血次数，但与同一国家或地区普通人群的患病率相当。考虑接受治疗的CKD患者应具有慢性HCV感染的病毒学证据（即血清中可检测到HCV RNA）。在CKD患者中治疗慢性HCV感染存在诸多挑战。随着肾小球滤过率（GFR）下降，干扰素（IFN）（标准干扰素和聚乙二醇化干扰素）和利巴韦林的半衰期都会延长，导致耐受性可能变差，在严重CKD中需要调整剂量。在肾移植受者中，使用IFN和免疫刺激剂还会带来显著的排斥风险。血液透析患者接受IFN治疗可产生良好的生化和病毒学反应，并且似乎对肾移植后的肝病进程有有益影响。在肾移植前，对维持性透析的HCV感染ESRD患者进行IFN-α治疗，在移植后阶段会有较高的持续生化和病毒学反应率。因此，对于有肾移植候选资格的HCV感染透析患者，IFN-α治疗似乎是可取的。
