Abstract: TH-PO202

Daclatasvir Plus Asunaprevir Treatment Ameliorated Proteinuria in Patients with HCV-Related Nephropathy in the Absence of Immunosuppressant

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Nihei, Yoshihito, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Suzuki, Hitoshi, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Nakayama, Maiko, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Kihara, Masao, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Gohda, Tomohito, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Suzuki, Yusuke, Juntendo University Faculty of Medicine, Tokyo, Japan
Background

The standard therapy of a chronic HCV infection is IFN monotherapy or IFN combined with ribavirin; however, after the introduction of direct-acting antivirals (DAAs), the standard therapy for patients with HCV genotype 1 has dramatically changed. However, the effects of DAAs on extra-hepatic manifestations such as HCV-related nephropathy (HCV-RN), especially in cases with renal dysfunction, are not well elucidated. We report a case of HCV-RN successfully treated by Daclatasvir and Asunaprevir, which are IFN-free DAAs for HCV.

Methods

A 66-year-old man was diagnosed as having chronic hepatitis C. Blood examination revealed a high copy number of HCV-RNA (genotype 1b). He presented with microscopic hematuria and proteinuria at the age of 56. After 7 years from the onset of urinary abnormalities, levels of urinary protein increased up to 5 g/gCr, and kidney biopsy was performed. Pathological findings of kidney biopsy specimens revealed mesangioproliferative glomerulonephritis with IgA deposition, and he was diagnosed as HCV-RN. He developed severe nephrotic syndrome with pleural effusion due to the hypoalbuminemia, therefore, we initiated treatment with oral corticosteroid (PSL). However, liver dysfunction was exacerbated and a copy number of HCV-RNA increased after treatment with PSL. Then, we changed medication from PSL to antiviral treatment with Daclatasvir/Asunaprevir. Clearance of HCV-RNA was obtained by 4 weeks and sustained, and microhematuria turned negative, proteinuria decreased (1.5 g/gCr) by 24 weeks. After 2 years from treatment with Daclatasvir/Asunaprevir, level of proteinuria was 0.8 g/gCr.

Conclusion

Patients with HCV infection have a higher risk of end-stage renal disease. This case offers original evidence for the application of newer generation of IFN-free DAAs in the treatment of HCV-RN.

Funding

  • Clinical Revenue Support