ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

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