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Comparative Study
. 2021 Aug 4;156(3):399-408.
doi: 10.1093/ajcp/aqaa238.

Spectrum of Kidney Diseases in Patients With Hepatitis C Virus Infection

Shunhua Guo  1 , Meghan E Kapp  2 , Diego M Beltran  3 , Cesar Y Cardona  4 , Dawn J Caster  5 , Ronald R Reichel  6 , Agnes B Fogo  2
Affiliations
Comparative Study

Spectrum of Kidney Diseases in Patients With Hepatitis C Virus Infection

Shunhua Guo et al. Am J Clin Pathol. .

Abstract

Objectives: To study the pathologic spectrum of kidney diseases in patients with hepatitis C virus infection (HCV+).

Methods: Native kidney biopsy specimens in HCV+ patients were reviewed.

Results: A total of 9,836 native kidney biopsy specimens were evaluated from January 2007 to December 2016, of which 273 (2.8%) were from HCV+ patients, and of these, 115 (42.1%) had diagnoses consistent with HCV-associated glomerulonephritis (GN). Non-HCV-associated kidney diseases comprised most diagnoses (158 cases, 57.9%) including non-immune complex-mediated kidney diseases (127 cases, 46.5%) and other immune complex-mediated glomerular diseases (31 cases, 11.4%). Forty-one (40.6%) patients had HCV-associated GN among 101 HCV+ patients from 2007 to 2011 vs 74 (43.0%) patients with HCV-associated GN among 172 HCV+ patients from 2012 to 2016. HCV-associated GN showed five morphologic patterns: focal proliferative (5.2%), diffuse mesangial proliferative (50.4%), diffuse membranoproliferative (28.7%), proliferative GN with crescentic lesions (7.8%), and membranous patterns (7.8%).

Conclusions: We found a spectrum of pathologic changes in renal biopsy specimens of HCV+ patients, with most having diseases unrelated to HCV infection, HCV-associated GN showing five morphologic patterns, and availability of effective HCV antiviral therapy not yet resulting in major changes in the spectrum of kidney diseases in these patients.

Keywords: Cryoglobulinemia; HCV-associated glomerulonephritis; Hepatitis C virus (HCV); Kidney disease.

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Figures

Image 1
Image 1
Pathologic features of hepatitis C virus (HCV)–associated glomerulonephritis. A, The classic kidney injury typically seen in HCV-associated glomerulonephritis is characterized by mesangial and endocapillary hypercellularity and double contours of the glomerular basement membrane (Jones’s silver, ×200). B, Cryoglobulin deposition can be demonstrated as periodic acid–Schiff stain-positive intraluminal cryo plugs, also called hyaline pseudothrombi in glomerular capillary lumens (×200). C-E, Immunofluorescence shows deposits with often immunoglobulin M dominance (C, ×200) and skewed light chain deposition (one light chain stronger than the other): κ light chain (D, ×200) and λ light chain (E, ×200). F, Electron microscopy shows subendothelial and mesangial deposits and intraluminal cryo plug with short fibrillary substructure (×8,900).
Image 1
Image 1
Pathologic features of hepatitis C virus (HCV)–associated glomerulonephritis. A, The classic kidney injury typically seen in HCV-associated glomerulonephritis is characterized by mesangial and endocapillary hypercellularity and double contours of the glomerular basement membrane (Jones’s silver, ×200). B, Cryoglobulin deposition can be demonstrated as periodic acid–Schiff stain-positive intraluminal cryo plugs, also called hyaline pseudothrombi in glomerular capillary lumens (×200). C-E, Immunofluorescence shows deposits with often immunoglobulin M dominance (C, ×200) and skewed light chain deposition (one light chain stronger than the other): κ light chain (D, ×200) and λ light chain (E, ×200). F, Electron microscopy shows subendothelial and mesangial deposits and intraluminal cryo plug with short fibrillary substructure (×8,900).
See this image and copyright information in PMC

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