Fabrizi F, Donato F, Messa P
Division of Nephrology, Ospedale Maggiore IRCCS Foundation, Milan, Italy -
Minerva Urol Nefrol. 2014 Jun;66(2):139-49.
The association between hepatitis C virus (HCV) infection and chronic kidney disease (CKD) is well established and remains an area of intense research. HCV infection is associated with a large spectrum of histo-pathological lesions in both native and transplanted kidneys. The frequency of kidney damage in HCV-infected patients appears low even if is not fully detailed. The most frequent HCV-associated renal lesion is type I membrano-proliferative glomerulonephritis, usually in the context of type II mixed cryoglobulinemia. Various approaches have been tried for the treatment of HCV-related glomerulonephritis, including immunosuppressive therapy (corticosteroids and cytotoxic agents), plasma exchange and antiviral agents. Antiviral treatment of HCV-associated glomerulonephritis has shown encouraging results. Immunosuppressive therapy is particularly recommended for cryoglobulinemic kidney disease. Two distinct approaches should be considered for the treatment of HCV-associated cryoglobulinemic glomerulonephritis according to the level of proteinuria and kidney failure. Some evidence on rituximab therapy for HCV-related cryoglobulinemic glomerulonephritis exists but several questions related to its use need to be addressed.
丙型肝炎病毒（HCV）感染与慢性肾脏病（CKD）之间的关联已得到充分证实，仍是一个深入研究的领域。HCV感染与天然肾和移植肾的多种组织病理学病变相关。HCV感染患者的肾损害发生率似乎较低，即便其情况尚未完全明确。最常见的与HCV相关的肾脏病变是I型膜增生性肾小球肾炎，通常发生在II型混合性冷球蛋白血症的背景下。已经尝试了各种方法来治疗HCV相关的肾小球肾炎，包括免疫抑制治疗（皮质类固醇和细胞毒性药物）、血浆置换和抗病毒药物。HCV相关肾小球肾炎的抗病毒治疗已显示出令人鼓舞的结果。免疫抑制治疗特别推荐用于冷球蛋白血症性肾病。根据蛋白尿水平和肾衰竭情况，治疗HCV相关冷球蛋白血症性肾小球肾炎应考虑两种不同的方法。关于利妥昔单抗治疗HCV相关冷球蛋白血症性肾小球肾炎有一些证据，但与其使用相关的几个问题仍需解决。
