Sohal Aalam, Singh Carol, Bhalla Akshita, Kalsi Harsimran, Roytman Marina
Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 2500, USA.
Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.
J Clin Med. 2024 Sep 18;13(18):5536. doi: 10.3390/jcm13185536.
Hepatitis C virus (HCV) has emerged as a major global health concern and, if left untreated, can lead to significant liver damage, including cirrhosis, decompensated liver disease, and hepatocellular carcinoma (HCC). Approximately 40% of patients with HCV infection experience extrahepatic manifestations, including renal involvement. HCV-related renal disease is of significant importance among patients with chronic kidney disease (CKD), leading to higher morbidity and mortality. The renal damage due to HCV infection primarily results from cryoglobulinemia and glomerulonephritis, with conditions such as membranoproliferative glomerulonephritis (MPGN) and membranous nephropathy (MN) being most prevalent. Despite advancements in treatment, including the use of directly acting antiviral agents (DAAs), renal complications remain a significant burden in untreated patients. HCV-positive patients on hemodialysis (HD) or those who have undergone kidney transplantation face increased mortality rates compared to their HCV-negative counterparts. Managing HCV infection before kidney transplantation is crucial to mitigate the risk of HCV-related renal complications. Conversely, kidney transplantation from HCV-infected donors is well established, as post-transplant treatment for HCV is safe and effective, potentially reducing mortality and morbidity for patients on transplant waiting lists. This review aims to provide a comprehensive analysis of the renal manifestations of HCV, emphasizing the importance of early diagnosis and treatment to improve patient outcomes.
丙型肝炎病毒（HCV）已成为全球主要的健康问题，如果不进行治疗，可能会导致严重的肝脏损害，包括肝硬化、失代偿性肝病和肝细胞癌（HCC）。大约40%的HCV感染患者会出现肝外表现，包括肾脏受累。在慢性肾脏病（CKD）患者中，HCV相关性肾病具有重要意义，会导致更高的发病率和死亡率。HCV感染导致的肾脏损害主要源于冷球蛋白血症和肾小球肾炎，其中膜增生性肾小球肾炎（MPGN）和膜性肾病（MN）最为常见。尽管在治疗方面取得了进展，包括使用直接抗病毒药物（DAAs），但肾脏并发症在未治疗的患者中仍然是一个重大负担。与HCV阴性的患者相比，接受血液透析（HD）的HCV阳性患者或接受过肾脏移植的患者死亡率更高。在肾脏移植前控制HCV感染对于降低HCV相关性肾脏并发症的风险至关重要。相反，来自HCV感染供体的肾脏移植已得到充分证实，因为HCV的移植后治疗是安全有效的，有可能降低移植等待名单上患者的死亡率和发病率。本综述旨在对HCV的肾脏表现进行全面分析，强调早期诊断和治疗对改善患者预后的重要性。
