Specific damage to the kidneys in patients with chronic hepatitis C associated with cryoglobulinemia
- Authors: Milovanova S.Y.1, Tegay S.V.1, Russkikh A.V.1, Kozlovskaya L.V.1, Milovanova SY.2, Tegai SV3, Russkikh AV2, Kozlovskaya LV2
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Affiliations:
- I.M. Sechenov First State Medical University, Moscow
- Research Center of I.M. Sechenov MSMU, Moscow
- Issue: Vol 83, No 11 (2011)
- Pages: 38-44
- Section: Editorial
- Submitted: 10.04.2020
- Published: 15.11.2011
- URL: https://ter-arkhiv.ru/0040-3660/article/view/30938
- ID: 30938
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Abstract
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.
Keywords
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, MoscowI.M. Sechenov First State Medical University, Moscow
S V Tegai
Research Center of I.M. Sechenov MSMU, MoscowResearch Center of I.M. Sechenov MSMU, Moscow
A V Russkikh
I.M. Sechenov First State Medical University, MoscowI.M. Sechenov First State Medical University, Moscow
L V Kozlovskaya
I.M. Sechenov First State Medical University, MoscowI.M. Sechenov First State Medical University, Moscow
References
- Pellicano R., Leone N., Maiocco I. A. et al. Chronic HCV hepatopathy and cryoglobulinemia. The associated clinical spectrum. Minerva Med. 1999; 90: 1-5.
- Козловская Л. В., Гордовская Н. Б., Малышко Е. Ю. и др. Клиническое значение смешанной криоглобулинемии. Рос. мед. журн. 2003; 4: 11-15.
- 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.
- Ferri С Mixed cryoglobulinemia. Orphanet J. Rare 2008; 3: 25.
- 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.
- D'Amico G. Renal involvement in hepatitis С infection: Cryoglobulinemic glomerulonephritis. Kidney Int. 1998; 54: 650- 657.
- Agnello V. Hepatitis С virus infection and II type cryoglobulinemia: an immunological perspective. Hepatology 1997; 26: 1375-1379.
- Kayali Z., Buckwold V. E., Zimmerman B., Hepatitis C., cryoglobulinemia and cirrhosis: a meta analysis. Hepatology 2002; 36: 978-985.
- Sansonno D., Dammacco F. Hepatitis С virus, cryoglobulinemia, and vasculitis: immune complex relations. Lancet Jnfect. Dis. 2005; 5 (4): 227-236.
- 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.
- Мухин Н. А., Козловская Л. В., Малышко Е. Ю. Криоглобулинемический нефрит, ассоциированный с хронической инфекцией вируса гепатита С. Тер. арх. 2000; 6: 1-5.
- 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.
- Zaja F., De Vita S., Mazzaro С. et al. Efficacy and safety of rituximab in type II mixed cryoglobulinemia. Blood 2003; 30: 3827-3834.
- 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.