Barsoum Rashad S, William Emad A, Khalil Soha S
Kasr-El-Aini Medical School, Cairo University, Cairo, Egypt; The Cairo Kidney Center, Cairo, Egypt.
The Cairo Kidney Center, Cairo, Egypt; National Research Centre, Cairo, Egypt.
J Adv Res. 2017 Mar;8(2):113-130. doi: 10.1016/j.jare.2016.07.004. Epub 2016 Jul 26.
Hepatitis-C (HCV) infection can induce kidney injury, mostly due to formation of immune-complexes and cryoglobulins, and possibly to a direct cytopathic effect. It may cause acute kidney injury (AKI) as a part of systemic vasculitis, and augments the risk of AKI due to other etiologies. It is responsible for mesangiocapillary or membranous glomerulonephritis, and accelerates the progression of chronic kidney disease due to other causes. HCV infection increases cardiovascular and liver-related mortality in patients on regular dialysis. HCV-infected patients are at increased risk of acute post-transplant complications. Long-term graft survival is compromised by recurrent or de novo glomerulonephritis, or chronic transplant glomerulopathy. Patient survival is challenged by increased incidence of diabetes, sepsis, post-transplant lymphoproliferative disease, and liver failure. Effective and safe directly acting antiviral agents (DAAs) are currently available for treatment at different stages of kidney disease. However, the relative shortage of DAAs in countries where HCV is highly endemic imposes a need for treatment-prioritization, for which a scoring system is proposed in this review. It is concluded that the thoughtful use of DAAs, will result in a significant change in the epidemiology and clinical profiles of kidney disease, as well as improvement of dialysis and transplant outcomes, in endemic areas.
丙型肝炎病毒（HCV）感染可导致肾损伤，主要原因是免疫复合物和冷球蛋白的形成，也可能是由于直接的细胞病变效应。它可能作为系统性血管炎的一部分引起急性肾损伤（AKI），并增加因其他病因导致AKI的风险。它可导致系膜毛细血管性或膜性肾小球肾炎，并加速其他原因所致慢性肾脏病的进展。HCV感染会增加接受定期透析患者的心血管疾病和肝脏相关死亡率。HCV感染患者发生移植后急性并发症的风险增加。复发性或新发肾小球肾炎或慢性移植肾小球病会损害长期移植物存活。糖尿病、脓毒症、移植后淋巴增殖性疾病和肝衰竭发病率的增加对患者生存构成挑战。目前有有效且安全的直接作用抗病毒药物（DAA）可用于治疗不同阶段的肾脏疾病。然而，在HCV高度流行的国家，DAA相对短缺，因此需要对治疗进行优先排序，本综述为此提出了一种评分系统。得出的结论是，在流行地区，谨慎使用DAA将导致肾脏疾病的流行病学和临床特征发生重大变化，并改善透析和移植结局。
