Abstract: TH-PO0798
Membranoproliferative Glomerulonephritis from Hepatitis C: Managing Treatment with Brain Lesions and Latent Tuberculosis
Session Information
- Glomerular Case Reports: Membranous, PGN, GBM, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Salud, Martina Isabel, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, United States
- Amtul, Raheem Raazia, Kakatiya Medical College, Warangal, Telangana, India
- Amarah, Amatur R., University of Illinois Chicago, Chicago, Illinois, United States
Introduction
We report a rare case of HCV-related MPGN with cryovasculitis, LTBI, and a brain lesion, complicating treatment decisions.
Case Description
A 55-year-old man with diabetes and hypertension presented with headaches, bilateral leg swelling, and a purpuric rash for a month. BP was 210/109 mmHg. Labs showed rising Cr (1.5 to 2.5 mg/dL), BUN 36, albumin 3.0 g/dL, and proteinuria (13 g/g). Urinalysis revealed hematuria, WBCs, and granular casts. Hepatitis C Ab and viral load (488,819) were positive, as were cryoglobulins. HIV, ANA, and ANCA were negative; C3 was low, C4 undetectable. Positive Quantiferon and a brain lesion raised concern for TB or neoplasm. Renal biopsy confirmed MPGN. He was homeless and initially ineligible for hepatitis C treatment. After thorough discussions with the healthcare teams and the patient about the potential benefits and risks of immunosuppression given the presence of a brain lesion without a definitive diagnosis, he was started on steroids and rituximab. Temporary housing was arranged, and hepatitis C treatment with glecaprevir/pibrentasvir was initiated. LTBI treatment began, renal function improved, and he achieved sustained virologic response.
Discussion
Membranoproliferative glomerulonephritis (MPGN) is a severe complication of HCV infection, presenting with nephritic syndrome—hematuria, proteinuria, edema, hypertension, and renal failure. Prognosis worsens with cryoglobulinemic vasculitis and glomerular cryoglobulin deposits. KDIGO recommends direct-acting antivirals like glecaprevir/pibrentasvir for first-line therapy to improve renal function and reduce proteinuria. Rituximab addresses autoimmune issues, especially in cryoglobulinemic flare or rapidly progressive glomerulonephritis. Treatment aims for sustained virologic response. This case underscores management complexity due to comorbidities and social challenges like access to care and treatment adherence.