Kwon Lawrence Hyun, Griffiths Jennifer, DiFranza Lanny
Department of Nephrology, Westchester Medical Center Advanced Physician Services, Mid-Hudson Regional Hospital, Poughkeepsie, NY, United States.
Department of Pathology, Montefiore Medical Center, Bronx, NY, United States.
Front Med (Lausanne). 2025 Jan 15;11:1434497. doi: 10.3389/fmed.2024.1434497. eCollection 2024.
Glecaprevir/pibrentasvir is an effective antiviral therapy for hepatitis C virus infection and is generally regarded safe in patients with renal impairment. However, renal complications are a notable, albeit rare, concern.
We report a case of acute kidney injury in a man in his 50s with chronic hepatitis C virus, chronic obstructive pulmonary disease, morbid obesity, a history of heroin dependence, and untreated type 2 diabetes mellitus. About four weeks into an eight-week glecaprevir/pibrentasvir regimen he developed progressive lower extremity edema, bullae, and skin ulcers with worsening renal function. His serum creatinine rose to 4.46 mg/dL and blood urea nitrogen to 44 mg/dL. ANCA serology revealed dual perinuclear and cytoplasmic positivity, though anti-proteinase 3 and anti-myeloperoxidase antibody tests were negative. Kidney biopsy revealed diffuse tubulointerstitial injury with erythrocyte casts indicative of glomerular bleeding into the distal nephrons, though without glomerular crescent formation.
This case illustrates the potential for glecaprevir/pibrentasvir to induce acute kidney injury, acute interstitial nephritis and possibly ANCA-associated vasculitis. Recognizing these adverse renal effects is critical for making timely diagnosis and management in hepatitis C virus patients undergoing antiviral therapy.
格卡瑞韦/哌柏西普是一种治疗丙型肝炎病毒感染的有效抗病毒疗法，一般认为对肾功能不全患者是安全的。然而，肾脏并发症是一个值得注意的问题，尽管很罕见。
我们报告一例50多岁男性的急性肾损伤病例，该患者患有慢性丙型肝炎病毒感染、慢性阻塞性肺疾病、病态肥胖、有海洛因依赖史且未治疗的2型糖尿病。在接受为期八周的格卡瑞韦/哌柏西普治疗方案约四周后，他出现了进行性下肢水肿、大疱和皮肤溃疡，同时肾功能恶化。他的血清肌酐升至4.46mg/dL，血尿素氮升至44mg/dL。抗中性粒细胞胞浆抗体血清学检查显示核周和胞浆双重阳性，尽管抗蛋白酶3和抗髓过氧化物酶抗体检测为阴性。肾脏活检显示弥漫性肾小管间质损伤，伴有红细胞管型，提示肾小球出血进入远端肾单位，但无肾小球新月体形成。
该病例表明格卡瑞韦/哌柏西普有诱发急性肾损伤、急性间质性肾炎以及可能的抗中性粒细胞胞浆抗体相关性血管炎的可能性。认识到这些不良肾脏影响对于接受抗病毒治疗的丙型肝炎病毒患者进行及时诊断和管理至关重要。
