Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France.
Transplantation. 2012 Mar 27;93(6):617-23. doi: 10.1097/TP.0b013e318245f14c.
Hepatitis E virus (HEV) infection is an emerging disease in industrialized countries. Few data regarding genotype 3 HEV extrahepatic manifestations exist.
We assessed kidney function and histology in solid-organ transplant patients during HEV infection. In all, 51 cases of genotype 3 HEV infections were diagnosed (34 kidney, 14 liver, and 3 kidney-pancreas transplant patients). Of these, 43.2% were cleared of the virus spontaneously within 6 months of infection, whereas 56.8% evolved to chronic hepatitis. Twelve of these patients completed a 3-month antiviral therapy and were followed up for 6 months posttreatment. Kidney function (estimated glomerular filtration rate [eGFR] obtained by the Modification of Diet in Renal Disease equation) and proteinuria were assessed before infection, during HEV infection and during follow-up. Kidney biopsies were obtained from patients with high proteinuria and decreased eGFR levels.
During HEV infection, there was a significant decrease in eGFR in both kidney- and liver-transplant patients. Glomerular diseases were observed in kidney biopsies obtained during the acute and chronic phases. This included membranoproliferative glomerulonephritis and relapses in IgA nephropathy. The majority of patients had cryoglobulinemia that became negative after HEV clearance. Kidney function improved and proteinuria decreased after HEV clearance.
HEV-associated glomerulonephritis seems to be an HEV-related extrahepatic manifestation. Further studies are required to confirm these observations.
戊型肝炎病毒 (HEV) 感染是工业化国家的一种新兴疾病。关于基因型 3 HEV 肝外表现的数据很少。
我们在 HEV 感染期间评估了实体器官移植患者的肾功能和组织学。共诊断出 51 例基因型 3 HEV 感染病例（34 例肾移植、14 例肝移植和 3 例肝肾联合移植患者）。其中，43.2%的患者在感染后 6 个月内自发清除病毒，而 56.8%的患者发展为慢性肝炎。其中 12 例患者完成了 3 个月的抗病毒治疗，并在治疗后随访 6 个月。在感染前、HEV 感染期间和随访期间评估肾功能（通过肾脏病饮食改良公式计算的估计肾小球滤过率[eGFR]）和蛋白尿。对于蛋白尿和 eGFR 水平降低的患者进行肾活检。
在 HEV 感染期间，肾移植和肝移植患者的 eGFR 均显著下降。在急性和慢性期的肾活检中观察到肾小球疾病。包括膜增殖性肾小球肾炎和 IgA 肾病的复发。大多数患者存在冷球蛋白血症，在 HEV 清除后转为阴性。HEV 清除后，肾功能改善，蛋白尿减少。
HEV 相关性肾小球肾炎似乎是一种与 HEV 相关的肝外表现。需要进一步研究来证实这些观察结果。
