Latt Nyan, Alachkar Nada, Gurakar Ahmet
Dr. Latt is a Resident Physician in the Internal Medicine Department at Greater Baltimore Medical Center in Baltimore, Maryland. Dr. Alachkar is an Assistant Professor of Medicine in the Division of Nephrology and Dr. Gurakar is an Associate Professor of Medicine in the Division of Gastroenterology & Hepatology and Medical Director of Liver Transplantation, both at Johns Hopkins University School of Medicine in Baltimore, Maryland.
Gastroenterol Hepatol (N Y). 2012 Jul;8(7):434-45.
Hepatitis C virus (HCV) causes chronic systemic infection, primarily affecting the liver. Although HCV mainly causes hepatitis, a significant portion of chronic HCV patients manifests with at least 1 extrahepatic involvement during the course of their illness. Chronic HCV infection can cause various types of renal diseases. The most common renal manifestations of HCV infection are essential mixed cryoglobulinemia leading to membranoproliferative glomerulonephritis (MPGN), MPGN without cryoglobulinemia, and membranous glomerulonephritis. On the other hand, patients with end-stage kidney disease are at an increased risk of acquiring HCV due to their frequent exposure to potentially contaminated devices in dialysis units and their long-term use of vascular access. Among dialysis patients or patients undergoing renal transplantation, the presence of HCV is associated with higher rates of mortality. The optimal antiviral therapy in patients with severe renal insufficiency is not yet well established and, in most cases, is associated with serious adverse effects. Randomized controlled trials looking at treatment options are lacking. This article reviews the pathophysiology of renal manifestations of chronic HCV infection, discusses recent insights into diagnostic and treatment options for HCV-induced glomerulopathies and HCV-infected dialysis patients, and describes the work-up of HCV-positive renal transplant candidates.
丙型肝炎病毒（HCV）可引起慢性全身性感染，主要影响肝脏。尽管HCV主要导致肝炎，但相当一部分慢性HCV患者在病程中会出现至少一种肝外受累情况。慢性HCV感染可导致各种类型的肾脏疾病。HCV感染最常见的肾脏表现是导致膜增生性肾小球肾炎（MPGN）的原发性混合性冷球蛋白血症、无冷球蛋白血症的MPGN以及膜性肾小球肾炎。另一方面，终末期肾病患者由于频繁接触透析单位中可能被污染的设备以及长期使用血管通路，感染HCV的风险增加。在透析患者或接受肾移植的患者中，HCV的存在与较高的死亡率相关。严重肾功能不全患者的最佳抗病毒治疗方法尚未完全确立，并且在大多数情况下会伴有严重的不良反应。目前缺乏针对治疗方案的随机对照试验。本文综述了慢性HCV感染肾脏表现的病理生理学，讨论了HCV诱导的肾小球病和HCV感染透析患者诊断及治疗选择的最新见解，并描述了HCV阳性肾移植候选者的检查过程。
