Abstract: TH-PO201

Hepatitis C Virus-Associated Glomerulonephritis Following Sustained Virological Response with Direct-Acting Antiviral Therapy

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Obrisca, Bogdan, Fundeni Clinical Institute, Bucharest, Romania
  • Jurubita, Roxana Adriana, Fundeni Clinical Institute, Bucharest, Romania
  • Berbecar, Vlad Teodor, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania, Bucharest, Romania
  • Sorohan, Bogdan Marian, Fundeni Clinical Institute, Bucharest, Romania
  • Andronesi, Andreea, Fundeni Clinical Institute, Bucharest, Romania
  • Ismail, Gener, Fundeni Clinical Institute, Bucharest, Romania
Background

Cryoglobulinemic membrano-proliferative glomerulonephritis (MPGN) is the most frequent type of renal involvement in HCV infection. The newer direct-acting antiviral (DAA) agents have been associated with sustained virological response (SVR) in over 95% of cases. However, the efficacy of this therapy on extrahepatic manifestations of HCV infection is still unknown. We report two cases of persistent and new-onset mixed cryoglobulinemia (MC) after successful eradication of HVC infection.

Methods

New onset MC. A 57 year-old male is admitted for purpuric rash and acute nephritic syndrome. His past medical history included psoriatic arthritis diagnosed 35 years ago and cirrhosis due to HCV infection (genotype 1b) for the past 11 years. Six months ago he received the ritonavir-boosted paritaprevir, ombitasvir and dasabuvir regimen and obtained SVR. Prior to this admission serum cryoglobulins were undetectable and urinalysis was unremarkable. The clinical exam revealed a purpuric rash on lower extremities, hepatomegaly and splenomegaly. Laboratory results are shown in table 1.The kidney biopsy was compatible with type I MPGN with extracapillary proliferation and the patient was started on cyclophosphamide and prednisone. After 6 months of immunosuppressive therapy the patient experienced a complete remission.
Persistent MC. A 50 year-old male presented with nephrotic syndrome (NS). He was known with HCV infection and MC with renal involvement for the past 15 and 2 years, respectively. Initially he received Rituximab and corticosteroids without a clinical response. Three months ago he received the ritonavir-boosted paritaprevir, ombitasvir and dasabuvir regimen and obtained SVR, but with persistence of NS. He underwent a kidney biopsy that showed MPGN with extracapillary proliferation after which he was started on cyclophosphamide. Baseline laboratory results are shown in table 1.

Conclusion

Despite successful viral eradication with the newer DAA agents there is increasingly recognition that clonal B cell expansion associated with HCV infection can still persist, thus maintaining the autoimmune manifestations.

Table 1`
 eGFR (ml/min)Serum Albumin (g/dl)Proteinuria (g/day)Serum C3 (mg/dl)Serum C4 (mg/dl)Cryoglobulins
Case 1683.71.9551.6Present
Case 2633.19.6983.6Present