Specific damage to the kidneys in patients with chronic hepatitis C associated with cryoglobulinemia

Full Text

Abstract

Aim. To reveal clinical and morphological characteristics of renal damage in patients with cryoglobulinemia (CGE) associated with chronic viral hepatitis C (CVH-C) for upgrading diagnosis, prognosis and optimization of the treatment methods.
Material and methods.Њ Two groups of CVH-C patients were studied: with CGE (group 1, n = 64) and free of CGE (group 2, n = 62) matched for gender, age and duration of the disease. Biopsy of the liver for assessment of the histological activity index and histological sclerosis index by METAVIR scale was conducted in 63 patients. Of patients with CGE-related damage to the kidneys, 48 were examined for clinical picture with morphological investigation of renal tissue in 15 of them including semiquantitative evaluation of fibrosis degree and activity.
Results. Patients with CVH-C and CGE had a wider spectrum of systemic lesions than CVH-C patients without CGE. Only CGE patients demonstrated more severe affection of the skin, joints, kidneys and the nervous system. Therefore, CGE can be considered as a marker of poor prognosis. Liver biopsy showed that CGE patients had more pronounced fibrosis (3-6 points) versus 0-2 points in 80% patients from group 2. Duration of CVH-C from probable infection to renal damage in 48 patients with CGE glomerulonephritis (GN) averaged 197.05±18.5 months. Renal biopsy diagnosed CGE mesangiocapillary GN in 13 patients and membranoproliferative GN in 2 patients. Patients with HCV infection had a more severe proliferative form of nephritis - mesangiocapillary GN. In 48 GN patients with HCV-infection and CGE, GN ran latently with moderate urinary syndrome in 29 (60.4%) patients, with nephrotic syndrome - in 9 (18.6%), with acute nephritic syndrome - in 10 (21.0%) patients. Most of the patients had arterial hypertension, 13 patients had creatinemia (3.02±0.55 mg/dl), rapidly progressive GN was diagnosed in 4 patients.
Conclusion. Persistent CGE marks poor prognosis in CHC patients and is an indication for antiviral treatment to prevent severe organ lesions, first of all of the kidneys. Development of CGE vasculitis with severe damage to the kidneys demands immunosuppressive therapy in combination with plasmapheresis or cryapheresis followed by antiviral drugs. As shown by pilot results, a new approach with rituximab is perspective but further evidence is needed for final conclusions.

About the authors

Svetlana Yur'evna Milovanova

Email: sveta@milovanova.ru

Sergey Vladimirovich Tegay

Aleksandr Vadimovich Russkikh

Email: avrussk@yandex.ru

Lidiya Vladimirovna Kozlovskaya

Email: sveta@milovanova.ru

S Yu Milovanova

I.M. Sechenov First State Medical University, Moscow

I.M. Sechenov First State Medical University, Moscow

S V Tegai

Research Center of I.M. Sechenov MSMU, Moscow

Research Center of I.M. Sechenov MSMU, Moscow

A V Russkikh

I.M. Sechenov First State Medical University, Moscow

I.M. Sechenov First State Medical University, Moscow

L V Kozlovskaya

I.M. Sechenov First State Medical University, Moscow

I.M. Sechenov First State Medical University, Moscow

References

  1. Pellicano R., Leone N., Maiocco I. A. et al. Chronic HCV hepatopathy and cryoglobulinemia. The associated clinical spectrum. Minerva Med. 1999; 90: 1-5.
  2. Козловская Л. В., Гордовская Н. Б., Малышко Е. Ю. и др. Клиническое значение смешанной криоглобулинемии. Рос. мед. журн. 2003; 4: 11-15.
  3. Cacoub P., Renou С, Rosenthal E. et al. Extrahepatic manifestations associated with hepatitis С virus infection. A prospective multicenter study of 321 patients. Medicine 2000; 79: 47- 56.
  4. Ferri С Mixed cryoglobulinemia. Orphanet J. Rare 2008; 3: 25.
  5. Trejo O., Ramos-Casals M., Garcia-Carrasco M. Cryoglobulinemia: study of etiologic factors and clinical and immunologic in 443 patients from a simple center. Medicine 2001; 8: 252-262.
  6. D'Amico G. Renal involvement in hepatitis С infection: Cryoglobulinemic glomerulonephritis. Kidney Int. 1998; 54: 650- 657.
  7. Agnello V. Hepatitis С virus infection and II type cryoglobulinemia: an immunological perspective. Hepatology 1997; 26: 1375-1379.
  8. Kayali Z., Buckwold V. E., Zimmerman B., Hepatitis C., cryoglobulinemia and cirrhosis: a meta analysis. Hepatology 2002; 36: 978-985.
  9. Sansonno D., Dammacco F. Hepatitis С virus, cryoglobulinemia, and vasculitis: immune complex relations. Lancet Jnfect. Dis. 2005; 5 (4): 227-236.
  10. Козловская Л. В., Мухин Н. А., Гордовская Н. Б. и др. Факторы риска прогрессирования криоглобулинемического гломерулонефрита, связанного с вирусом гепатита С. Клин. мед. 2001; 4: 32-35.
  11. Мухин Н. А., Козловская Л. В., Малышко Е. Ю. Криоглобулинемический нефрит, ассоциированный с хронической инфекцией вируса гепатита С. Тер. арх. 2000; 6: 1-5.
  12. Tarantino A., Campisc M., Banfi G. et al. Long-term predictors of survival in essential mi[ed eryoglobulinemie glomerulonephritis. Kidney Int. 1995; 47: 618-623.
  13. Zaja F., De Vita S., Mazzaro С. et al. Efficacy and safety of rituximab in type II mixed cryoglobulinemia. Blood 2003; 30: 3827-3834.
  14. Zuckerman E., Keren D., Slobodin G. et al. Treatment of refractory, symptomatic hepatitis С virus related mixed cryoglobulinemia with ribavirin and interferon-α. J. Rheumatol. 2000; 27: 2172-2178.

Statistics

Views

Abstract: 165

Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2011 Milovanova S.Y., Tegay S.V., Russkikh A.V., Kozlovskaya L.V., Milovanova S.Y., Tegai S.V., Russkikh A.V., Kozlovskaya L.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies