Shimada Michiko, Nakamura Norio, Endo Tetsu, Yamabe Hideaki, Nakamura Masayuki, Murakami Reiichi, Narita Ikuyo, Tomita Hirofumi
Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Japan, 036-8562.
Community Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
BMC Nephrol. 2017 Mar 29;18(1):109. doi: 10.1186/s12882-017-0534-5.
Direct-acting antivirals (DAAs) dramatically improve the treatment of hepatitis C virus (HCV) infections. However, the effects of DAAs on extra-hepatic manifestations such as HCV-associated glomerulonephritis, especially in cases with renal dysfunction, are not well elucidated.
A 69-year-old Japanese woman was diagnosed as having chronic hepatitis C, genotype 1b at the age of 55. She presented with hypertension, microscopic hematuria, proteinuria, renal dysfunction, purpura, and arthralgia at the age of 61. She also had hypocomplementemia and cryoglobulinemia. Renal biopsy revealed membranoproliferative glomerulonephritis (MPGN), and she was diagnosed as having HCV-associated cryoglobulinemic MPGN. She declined interferon therapy at the time and was treated with antihypertensive medications as well as oral corticosteroid that were effective in reducing proteinuria. However, when the corticosteroid dose was reduced, proteinuria worsened. She began antiviral treatment with daclatasvir/asunaprevir (DCV/ASV). Clearance of HCV-RNA was obtained by 2 weeks and sustained, and liver function was normalized. In addition, microhematuria turned negative, proteinuria decreased, hypocomplementemia and estimated glomerular filtration rate were improved, whereas cryoglobulinemia persisted. She completed 24 weeks of therapy without significant adverse effects.
In a case of HCV-associated cryoglobulinemic MPGN with renal dysfunction, DCV/ASV -based DAAs ameliorated microhematuria, proteinuria and renal function without significant side effects.
直接抗病毒药物（DAAs）显著改善了丙型肝炎病毒（HCV）感染的治疗效果。然而，DAAs对肝外表现如HCV相关肾小球肾炎的影响，尤其是在肾功能不全的病例中，尚未得到充分阐明。
一名69岁的日本女性在55岁时被诊断为慢性丙型肝炎，基因1b型。她在61岁时出现高血压、镜下血尿、蛋白尿、肾功能不全、紫癜和关节痛。她还存在低补体血症和冷球蛋白血症。肾活检显示为膜增生性肾小球肾炎（MPGN），她被诊断为HCV相关冷球蛋白血症性MPGN。当时她拒绝了干扰素治疗，接受了抗高血压药物以及口服皮质类固醇治疗，这些治疗在减少蛋白尿方面有效。然而，当皮质类固醇剂量减少时，蛋白尿加重。她开始使用daclatasvir/asunaprevir（DCV/ASV）进行抗病毒治疗。2周时获得了HCV-RNA清除并持续存在，肝功能恢复正常。此外，镜下血尿转阴，蛋白尿减少，低补体血症和估计肾小球滤过率得到改善，而冷球蛋白血症持续存在。她完成了24周的治疗，没有明显的不良反应。
在一例伴有肾功能不全的HCV相关冷球蛋白血症性MPGN病例中，基于DCV/ASV的DAAs改善了镜下血尿、蛋白尿和肾功能，且无明显副作用。
