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. 2022 Apr-Jun;44(2):291-295.
doi: 10.1590/2175-8239-JBN-2020-0148.

Hepatitis C-related membranoproliferative glomerulonephritis in the era of direct antiviral agents

[Article in English, Portuguese]
Walid Ahmed Ragab Abdelhamid  1 , Ali Shendi  1 , Mahmoud Zahran  1 , Eman Abd Elbary  2 , Sawsan Fadda  3
Affiliations

Hepatitis C-related membranoproliferative glomerulonephritis in the era of direct antiviral agents

[Article in English, Portuguese]
Walid Ahmed Ragab Abdelhamid et al. J Bras Nefrol. 2022 Apr-Jun.

Abstract
in English, Portuguese

Membranoproliferative glomerulonephritis (MPGN) is the most typical Hepatitis C virus (HCV)-associated glomerulopathy, and the available data about the utilization of direct-acting antivirals (DAA) in HCV-associated glomerulonephritis is inadequate. We evaluated the renal and viral response in two cases of HCV-related MPGN; the first caused by cryoglobulinemia while the second was cryoglobulin-negative. Both patients received immunosuppression besides DAA in different regimens. They achieved partial remission but remained immunosuppression-dependent for more than 6 months after DAA despite sustained virological response, which enabled safer but incomplete immunosuppression withdrawal. Both patients were tested for occult HCV in peripheral blood mononuclear cells and found to be negative. Hence, the treatment of HCV-related MPGN ought to be according to the clinical condition and the effects of drug therapy. It is important to consider that renal response can lag behind the virological response.

A glomerulonefrite membranoproliferativa (GNMP) é a glomerulopatia associada ao vírus mais típico da hepatite C (HCV), e os dados disponíveis sobre a utilização de antivirais de ação direta (AAD) na glomerulonefrite associada ao HCV são inadequados. Avaliamos a resposta renal e viral em dois casos de GNMP relacionados ao HCV; o primeiro causado por crioglobulinemia, enquanto o segundo era negativo para crioglobulina. Ambos os pacientes receberam imunossupressão além de AAD em diferentes esquemas terapêuticos. Eles alcançaram remissão parcial, mas permaneceram dependentes da imunossupressão por mais de 6 meses após os AAD, apesar da resposta virológica sustentada, que permitiu a retirada da imunossupressão mais segura, mas incompleta. Ambos os pacientes foram testados para HCV oculto em células mononucleares do sangue periférico e deram resultados negativos. Portanto, o tratamento do GNMP relacionado ao VHC deve ser de acordo com a condição clínica e os efeitos da terapia medicamentosa. É importante considerar que a resposta renal pode ficar aquém da resposta virológica.

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Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflict of interest related to the publication of this manuscript.

Figures

Figure 1
Figure 1. Graph showing creatinine and proteinuria change over follow-up period in case 1.
Figure 2
Figure 2. Graph showing creatinine and proteinuria change over follow-up period in case 2. IS: immunosuppression.
See this image and copyright information in PMC

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