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Méndez-Sánchez N, Coronel-Castillo CE, Ramírez-Mejía MM. Chronic Hepatitis C Virus Infection, Extrahepatic Disease and the Impact of New Direct-Acting Antivirals. Pathogens 2024; 13:339. [PMID: 38668294 PMCID: PMC11053783 DOI: 10.3390/pathogens13040339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
Chronic hepatitis C virus infection is an important cause of liver cirrhosis, hepatocellular carcinoma and death. Furthermore, it is estimated that about 40-70% of patients develop non-hepatic alterations in the course of chronic infection. Such manifestations can be immune-related conditions, lymphoproliferative disorders and metabolic alterations with serious adverse events in the short and long term. The introduction of new Direct-Acting Antivirals has shown promising results, with current evidence indicating an improvement and remission of these conditions after a sustained virological response.
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Affiliation(s)
- Nahum Méndez-Sánchez
- Unit Liver Research, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico;
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | | | - Mariana Michelle Ramírez-Mejía
- Unit Liver Research, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico;
- Plan of Combined Studies in Medicine (PECEM MD/PhD), Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico
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Gaudji GR, Bida M, Conradie M, Damane BP, Bester MJ. Renal Papillary Necrosis (RPN) in an African Population: Disease Patterns, Relevant Pathways, and Management. Biomedicines 2022; 11:biomedicines11010093. [PMID: 36672600 PMCID: PMC9855351 DOI: 10.3390/biomedicines11010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Renal papillary necrosis (RPN) is characterized by coagulative necrosis of the renal medullary pyramids and papillae. Multiple conditions and toxins are associated with RPN. Several RPN risk factors, or POSTCARDS, have been identified, with most patients presenting with RPN having at least two contributing risk factors. Currently, there is no specific test to diagnose and confirm RPN; however, several imaging tools can be used to diagnose the condition. RPN is currently underdiagnosed in African populations, often with fatal outcomes. In African clinical settings, there is a lack of consensus on how to define and describe RPN in terms of kidney anatomy, pathology, endourology, epidemiology, the identification of African-specific risk factors, the contribution of oxidative stress, and lastly an algorithm for managing the condition. Several risk factors are unique to African populations including population-specific genetic factors, iatrogenic factors, viral infections, antimicrobial therapy, schistosomiasis, substance abuse, and hypertension (GIVASSH). Oxidative stress is central to both GIVASSH and POSTCARDS-associated risk factors. In this review, we present information specific to African populations that can be used to establish an updated consensual definition and practical grading system for radiologists, urologists, nephrologists, nuclear physicians, and pathologists in African clinical settings.
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Affiliation(s)
- Guy Roger Gaudji
- Department of Urology, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa
- Correspondence: (G.R.G.); (M.J.B.)
| | - Meshack Bida
- Department of Anatomical Pathology, National Health Laboratory Service (NHLS), Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa
| | - Marius Conradie
- Urology Practice, Netcare Waterfall City Hospital, Cnr Magwa Avenue and Mac Mac Road, Johannesburg 1682, South Africa
| | - Botle Precious Damane
- Department of Surgery, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa
| | - Megan Jean Bester
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa
- Correspondence: (G.R.G.); (M.J.B.)
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Chen W, Fan Z, Huang C, Liu J. Poricoic Acid A Inhibits the NF- κB/MAPK Pathway to Alleviate Renal Fibrosis in Rats with Cardiorenal Syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:8644353. [PMID: 35754696 PMCID: PMC9217574 DOI: 10.1155/2022/8644353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the potential and mechanism of action of poricoic acid A (PAA) in treatment of cardiorenal injury and fibrosis due to cardiorenal syndrome (CRS). Materials and Methods A CRS rat model was established by transabdominal subtotal nephrectomy (STNx). The experimental group was treated by gavage of PAA (10 mg/kg/day). After 8 weeks of treatment, echocardiography was utilized for detecting heart-related indexes in rats. HE and Masson staining were conducted to detect the degree of pathological damage and fibrosis in rat kidney tissue, respectively. In addition, serum blood urea nitrogen (BUN), serum creatinine (SCr), and 24-hour urine protein were measured biochemically. Also, the levels of inflammatory factors (IL-1β, IL-6, and IL-10) in rat kidneys were measured using ELISA. Western blot was used to examine the expression of NF-κB/MAPK pathway-related proteins. Results In this study, a CRS rat model was successfully established by STNx surgery. PAA treatment could significantly alleviate the damage of heart and kidney function in CRS rats and reduce the pathological damage of kidney tissue and renal fibrosis. Meanwhile, PAA could also inhibit the renal inflammatory response through downregulating IL-1β and IL-6 levels in the kidney tissue and upregulating IL-10 level. Further mechanism exploration showed that the NF-κB/MAPK signaling pathway was significantly activated in CRS rats, while PAA treatment could markedly inhibit the NF-κB/MAPK signaling pathway activity in CRS rats. Conclusion PAA can obviously improve the pathological damage and fibrosis of renal tissue in CRS rats and maintain the function of the heart and kidney. The above functions of PAA may be achieved by inhibiting the NF-κB/MAPK signaling pathway activity. Briefly speaking, PAA can serve as a potential drug for CRS treatment.
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Affiliation(s)
- Wenzhong Chen
- Department of Cardiovascular Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China
| | - Zhiwen Fan
- Department of Cardiology, The PLA 74th Group Army Hospital, Guangzhou, Guangdong 510300, China
| | - Canhui Huang
- Department of Cardiovascular Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China
| | - Junying Liu
- Department of Endocrinology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, Guangdong 518000, China
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Pérez de José A, Carbayo J, Pocurull A, Bada-Bosch T, Cases Corona CM, Shabaka A, Ramos Terrada N, Martinez Valenzuela L, Huerta A, Fernandez Lorente L, Malek-Marín TG, Goicoechea M. Direct-acting antiviral therapy improves kidney survival in hepatitis C virus-associated cryoglobulinaemia: the RENALCRYOGLOBULINEMIC study. Clin Kidney J 2020; 14:586-592. [PMID: 33623683 PMCID: PMC7886557 DOI: 10.1093/ckj/sfz178] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background Direct-acting antiviral agents (DAAs) have shown high rates of sustained virological response in chronic hepatitis C virus (HCV) infection. However, the influence of DAAs on the course of kidney involvement in HCV-associated mixed cryoglobulinaemia (HCV-MC) has been little studied. The aim of this study was to analyse the effects of antiviral treatment on kidney prognosis and evolution in patients diagnosed with HCV-MC. Methods The RENALCRYOGLOBULINEMIC study is an observational multicentre cohort study of 139 patients with HCV-MC from 14 Spanish centres. Clinical and laboratory parameters were measured before and after antiviral treatment. Primary endpoints were kidney survival and mortality after HCV-MC diagnosis. Secondary endpoints were clinical, immunological and virological responses after antiviral treatment. Results Patients were divided into three groups based on the treatment received: treatment with DAAs (n = 100) treatment with interferon (IFN) and ribavirin (RBV) (n = 24) and no treatment (n = 15). Patients were followed up for a median duration of 138 months (interquartile range 70-251. DAA treatment reduced overall mortality {hazard ratio [HR] 0.12 [95% confidence interval (CI) 0.04-0.40]; P < 0.001} and improved kidney survival [HR 0.10 ( 95% CI 0.04-0.33); P < 0.001]. Conclusions Results from the RENALCRYOGLOBULINEMIC study indicated that DAA treatment in patients with HCV-MC improves kidney survival and reduces mortality.
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Affiliation(s)
- Ana Pérez de José
- Department of Nephrology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Carbayo
- Department of Nephrology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Anna Pocurull
- Department of Gastroenterology and Hepatology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Teresa Bada-Bosch
- Department of Nephrology, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Amir Shabaka
- Department of Nephrology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain
| | | | | | - Marian Goicoechea
- Department of Nephrology, University Hospital Gregorio Marañón, Madrid, Spain
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Hepatitis C virus antibodies in outpatients with chronic kidney disease. Clin Exp Hepatol 2018; 4:267-270. [PMID: 30603675 PMCID: PMC6311740 DOI: 10.5114/ceh.2018.80129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/10/2018] [Indexed: 11/17/2022] Open
Abstract
Aim of the study To determine the seroprevalence of hepatitis C virus (HCV) in outpatients with chronic kidney disease (CKD) attending a nephrology clinic. Material and methods Prospective observational study on consecutive outpatients attending a nephrology clinic. Inclusion criteria were age > 18 years, CKD, informed consent. There were no exclusion criterias. Recorded variables were age, gender, CKD grade and etiology, anti-HCV antibodies (Ab). Patients with positive HCV Abs were tracked for HCV RNA detection. Study interval was from November 2015 to March 2016. The study has been approved by the Ethic committee of F.D. Roosevelt University Hospital. Funded by Restricted Grant of AbbVie Slovakia. Results One hundred and thirty-four patients were enrolled, with median age 70 years (19.7-91), 52% women. CKD grades: G1/2 – 52 patients (39%), G3a – 34 patients (25%), G3b – 32 patients (24%), G4 – 8 patients (6%), G5 – 8 patients (6%); CKD etiology: tubulointerstitial nephritis (TIN) – 53 patients (40%), nephrosclerosis (NS) – 30 patients (22%), diabetic nephropathy (DN) – 23 patients (17%), glomerulonephritis (GN) – 23 patients (17%), others – 5 patients (4%). Anti-HCV antibodies were detected in 8 patients (6%). There were no significant differences in CKD grades between HCV+ and HCV– patients; Heymann nephritis and GN were significantly more frequent in HCV– patients, as was male gender. Of 8 HCV Ab positive patients, 5 were available for HCV RNA testing (2 died after completion of the study, 1 was lost to follow-up); of them, 1 patient tested positive. Conclusions Prevalence of anti-HCV antibodies in CKD patients was 6%, which is 4 times higher than in the general population of Slovakia; HCV RNA was detected in 1 patient (12.5%) of anti-HCV positive patients. Based on this result, multicentric, a larger-scale study is considered to be warranted.
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Soliman AR, Ahmed RM, Soliman M, Abdallah A, Zayed B. The effect of co-infection with hepatitis B and hepatitis C viruses on the prevalence of proteinuria and loss of renal function: a single-center experience. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_51_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Park H, Chen C, Wang W, Henry L, Cook RL, Nelson DR. Chronic hepatitis C virus (HCV) increases the risk of chronic kidney disease (CKD) while effective HCV treatment decreases the incidence of CKD. Hepatology 2018; 67:492-504. [PMID: 28873225 PMCID: PMC5814730 DOI: 10.1002/hep.29505] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
Abstract
We assessed the risk of chronic kidney disease (CKD) in chronic hepatitis C virus (HCV)-infected patients and the incidence reduction of CKD after receipt of HCV treatment. We also evaluated the risk of membranoproliferative glomerulonephritis (MPGN) and cryoglobulinemia in chronic HCV patients. A retrospective cohort analysis of the Truven Health MarketScan Database (2008-2015) in the United States was conducted. In a cohort of 56,448 HCV-infected patients and 169,344 propensity score (1:3)-matched non-HCV patients, we examined the association of HCV infection with the incidence of CKD. Of 55,818 HCV patients, 6.6 % (n = 3666), 6.3% (n = 3534), and 8.3% (n = 4628) patients received either interferon-based dual, triple, or all-oral direct acting antiviral agent therapy, respectively, whereas 79% of patients did not receive any HCV treatment. Cox proportional hazards models were used to compare the risk of developing CKD in HCV patients compared with non-HCV patients and treated patients compared with untreated HCV patients. In a multivariate time-varying Cox regression model, HCV-infected patients had a 27% increased risk of CKD compared with non-HCV patients (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.18-1.37). Among HCV patients, individuals who received the minimally effective HCV treatment for dual, triple, or all-oral therapy had a 30% decreased risk of developing CKD (HR, 0.70; 95% CI, 0.55-0.88). In addition, HCV-infected patients experienced a twofold and a nearly 17-fold higher risk of MPGN (HR, 2.23; 95% CI, 1.84-2.71) and cryoglobulinemia (HR, 16.91; 95% CI, 12.00-23.81) respectively, compared with non-HCV patients. Conclusion: HCV-infected individuals in the United States are at greater risk of developing CKD, MPGN, and cryoglobulinemia. Minimally effective treatment of HCV infection can prevent the development of CKD, although the association was not significant for all-oral therapy. (Hepatology 2018;67:492-504).
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Affiliation(s)
- Haesuk Park
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Chao Chen
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Wei Wang
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Linda Henry
- Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Robert L. Cook
- Department of MedicineUniversity of FloridaGainesvilleFL
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Ostojic P, Jeremic IR. Managing refractory cryoglobulinemic vasculitis: challenges and solutions. J Inflamm Res 2017; 10:49-54. [PMID: 28507447 PMCID: PMC5428757 DOI: 10.2147/jir.s114067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cryoglobulinemia is thought to be a rare condition. It may be an isolated disorder or secondary to a particular disease. According to immunoglobulin composition, cryoglobulinemia is classified into three types. In mixed cryoglobulinemia (types II and III), vascular deposition of cryoglobulin-containing immune complexes and complement may induce a clinical syndrome, characterized by systemic vasculitis and inflammation – cryoglobulinemic vasculitis (CryoVas). Most common clinical manifestations in CryoVas are skin lesions (orthostatic purpura and ulcers), weakness, peripheral neuropathy, Raynaud’s phenomenon, sicca syndrome, membranoproliferative glomerulonephritis, and arthralgia and seldom arthritis. In patients with mixed cryoglobulinemia, prevalence of anti-hepatitis C virus (HCV) antibodies and/or HCV RNA, detected by polymerase chain reaction (PCR), is reported to be up to 90%, indicating a significant role of HCV in the development of this condition. The goals of therapy for mixed cryoglobulinemia include immunoglobulin level reduction and antigen elimination. CryoVas not associated with HCV infection should be treated according to treatment recommendations for small-vessel vasculitides. CryoVas associated with chronic HCV infection should be treated with antivirals along with immunosuppressive drugs, with or without plasmapheresis, depending on disease severity and organ involvement. Patients who do not respond to first-line therapy may achieve remission when treatment with rituximab is started as second-line therapy. In HCV-related CryoVas, antiviral therapy should be given along with rituximab in order to achieve complete or partial remission. Moreover, rituximab has proven to be a glucocorticoid-sparing medication. Other potential therapies for refractory CryoVas include mycophenolate mofetil and belimumab, while tumor necrosis factor (TNF) inhibitors are not effective.
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Affiliation(s)
- Predrag Ostojic
- Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan R Jeremic
- Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, Serbia
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Sise ME, Bloom AK, Wisocky J, Lin MV, Gustafson JL, Lundquist AL, Steele D, Thiim M, Williams WW, Hashemi N, Kim AY, Thadhani R, Chung RT. Treatment of hepatitis C virus-associated mixed cryoglobulinemia with direct-acting antiviral agents. Hepatology 2016; 63:408-17. [PMID: 26474537 PMCID: PMC4718772 DOI: 10.1002/hep.28297] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/12/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) is the most common cause of mixed cryoglobulinemia syndrome (MCS). The efficacy and safety of all-oral direct-acting antiviral (DAA) therapy in HCV-associated MCS (HCV-MCS) is largely unknown. The authors studied case series of patients with HCV-MCS who were treated with sofosbuvir-based regimens and historical controls treated with pegylated interferon and ribavirin in a single health care network. HCV-MCS was defined by circulating cryoglobulin associated with systemic vasculitis symptoms. Renal involvement (n = 7) was established by kidney biopsy (n = 5) or by two or more of the following clinical findings: reduced kidney function, proteinuria, or hematuria with other causes excluded (n = 2). Twelve patients received DAA therapy between December 2013 and September 2014. Median age was 61 years, 58% were male, and 50% had cirrhosis. Median baseline serum creatinine was 0.97 mg/dL (range 0.7-2.47). Four patients received rituximab concurrent with DAA therapy. Sustained virological response rate at 12 weeks (SVR12) was 83% overall. Patients with glomerulonephritis who achieved SVR12 experienced an improvement in serum creatinine and a reduction in proteinuria. Cryoglobulin levels decreased in 89% of patients, with median percent decreasing from 1.5% to 0.5% and completely disappearing in four of nine cases who had cryoglobulins measured after treatment. Serious adverse events were infrequent (17%). In contrast, the historical cohort treated with pegylated interferon and ribavirin experienced only 10% SVR12, with 100% experiencing at least one adverse event and 50% experiencing premature discontinuation due to adverse events. CONCLUSION SVR12 rates for sofosbuvir-based DAA regimens in HCV-MCS were 83%, significantly higher than historical controls treated with pegylated interferon and ribavirin; patients with glomerulonephritis experienced improvement in renal function, including those not concomitantly treated with immunosuppression.
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Affiliation(s)
- Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Allyson K. Bloom
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital
| | - Jessica Wisocky
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Ming V. Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Brigham and Women’s Hospital
| | - Jenna L. Gustafson
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Andrew L. Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - David Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Michael Thiim
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Winfred W. Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Nikroo Hashemi
- Division of Gastroenterology and Hepatology, Department of Medicine, Brigham and Women’s Hospital
| | - Arthur Y. Kim
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital
| | - Ravi Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Raymond T. Chung
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
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Nobakht E, Cohen SD, Rosenberg AZ, Kimmel PL. HIV-associated immune complex kidney disease. Nat Rev Nephrol 2016; 12:291-300. [PMID: 26782145 DOI: 10.1038/nrneph.2015.216] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The introduction in the late 20(th) century of combination antiretroviral therapy (cART) to treat patients infected with HIV has changed the natural history of the disease from an acute illness that rapidly culminates in death, to a chronic condition that can be managed with medications. Over the past decade the epidemiology of kidney disease in US patients infected with HIV has changed, perhaps because of the increased availability and use of cART. Patients with HIV infection exhibit unique immunologic characteristics, including immunodeficiency and dysregulation of immunoglobulin synthetic responses and T-cell function, which can result in glomerular immune complex deposition and subsequent kidney injury. This Review examines the differential diagnoses of HIV-associated immune complex kidney diseases (HIVICD), and discusses the clinical manifestations and mechanisms underlying their development. We address the issues associated with treatment, clinical outcomes, and research needs to enhance our ability to diagnose and optimally treat patients with HIVICD.
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Affiliation(s)
- Ehsan Nobakht
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW #3-438, Washington, District of Columbia 20037, USA
| | - Scott D Cohen
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW #3-438, Washington, District of Columbia 20037, USA
| | - Avi Z Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, Maryland 21287, USA
| | - Paul L Kimmel
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW #3-438, Washington, District of Columbia 20037, USA
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Pavinic J, Miglinas M. The incidence of possible causes of membranoproliferative glomerulonephritis: a single-center experience. Hippokratia 2015; 19:314-318. [PMID: 27688695 PMCID: PMC5033141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Diagnosis of membranoproliferative glomerulonephritis (MPGN) is based on kidney biopsy findings: unique glomerular injury pattern and characteristic changes on light, electron microscopy and immunohistochemical analysis. The purpose of this study was to identify possible etiology and incidence of glomerular injury among patients with a diagnosed MPGN. MATERIALS AND METHODS A retrospective analysis (years 2000-2014) of 81 clinical cases with a diagnosis of MPGN based on biopsy results was performed. Records were examined, and data about viral, bacterial infections, autoimmune and hematological diseases was collected. Test results of blood C3 and C4 factors of the complement system, and results of kidney biopsy immunohistochemical analysis were investigated. Statistical analysis was performed using Statistical Package for the Social Sciences and p-value less than 0.05 was considered statistically significant. RESULTS Study population consisted of 55 males (67.9%) and 26 females (32.1%). The average patients' age was 48.53 (standard deviation ± 16.67) years. The identified etiology of MPGN was: idiopathic in 26 cases (32.10%), bacterial infections in 20 cases (24.69%), viral hepatitis in 16 cases (19.75%), autoimmune diseases in 11 cases (13.58%), and hematological diseases in eight cases (9.88%). Changes of the concentration of complement component C3 as well as component C4 were found; their concentration was decreased in 26 (32.1%) and 17 (20.99%) patients' respectively while concentration was within the normal range in 11 (13.58%) and 19 (23.46%) patients respectively. Immunohistochemistry results revealed immunoglobulin (Ig) deposits: C3+/Ig+ was found in 47 (58.02%) cases, C3-/Ig+ was found in 16 (19.75%) cases and in six (7.41%) cases test was not performed. The total number of immunoglobulin positive biopsies (C3+/Ig+ and C3-/Ig+, also called immune-complex mediated MPGN) was 63 (77.78%). Complement-mediated MPGN (C3+/Ig-) was less common and was diagnosed only in seven cases (8.64%). C3-/Ig- was found in five cases (6.17%). CONCLUSIONS The leading cause of MPGN was idiopathic as well as bacterial infections. Complement component C3 concentration was mostly decreased. The incidence of normal and decreased concentration of the complement component C4 was almost equal. Most immunohistochemical deposits in kidney biopsy appeared to be C3/Ig positive, and it was observed in more than half of the cases of each MPGN etiological group. Hippokratia 2015; 19 (4): 314-318.
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Affiliation(s)
- J Pavinic
- Nephrology Center of Vilnius University, Vilnius, Lithuania
| | - M Miglinas
- Nephrology Center of Vilnius University, Vilnius, Lithuania
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Anis S, Abbas K, Mubarak M, Ahmed E, Bhatti S, Muzaffar R. Vasculitis with renal involvement in essential mixed cryoglobulinemia: Case report and mini-review. World J Clin Cases 2014; 2:160-166. [PMID: 24868518 PMCID: PMC4023312 DOI: 10.12998/wjcc.v2.i5.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/17/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023] Open
Abstract
The discovery of a strong association between hepatitis C virus (HCV) infection and mixed cryoglobulinemia (MC) has led to an increasingly rare diagnosis of idiopathic essential MC (EMC). The incidence of EMC is high in regions where there is a comparatively low HCV infection burden and low in areas of high infection prevalence, including HCV. The diagnosis of EMC requires an extensive laboratory investigation to exclude all possible causes of cryoglobulin formation. In addition, although cryoglobulin testing is simple, improper testing conditions will result in false negative results. Here, we present a 46-year-old female patient with a case of EMC with dermatological and renal manifestations, highlighting the importance of extensive investigation to reach a proper diagnosis. We review the need for appropriate laboratory testing, which is often neglected in clinical practice and which can result in false negative results. This review also emphasizes the significance of an extended testing repertoire necessary for better patient management. Despite a strong association of MC with HCV infection and other causes that lead to cryoglobulin formation, EMC remains a separate entity. Correct diagnosis requires proper temperature regulation during sample handling, as well as characterization and quantification of the cryoprecipitate. Inclusion of rheumatoid factor activity and complement levels in the cryoglobulin test-panel promotes better patient management and monitoring. Consensus guidelines should be developed and implemented for cryoglobulin detection and the diagnosis of cryoglobulinemic syndrome, which will reduce variability in inter-laboratory reporting.
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