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Hepatitis C virus risk: a hepatitis C virus related syndrome
C Mazzaro1, G Panarello, F Tesio
1First Division of Medicine, Blood Bank Service of Pordenone General Hospital, Pordenone, Italy.
Insights
Hepatitis C virus (HCV)-positive patients with mixed cryoglobulinemia (MC) and kidney involvement have a new syndrome with poor survival but do not progress to kidney failure. Infections are the main cause of death in these patients.
Area of Science:
- Nephrology
- Hepatology
- Immunology
Background:
- Hepatitis C virus (HCV) infection is associated with mixed cryoglobulinemia (MC).
- The long-term prognosis of HCV-positive patients with MC requires further investigation, particularly regarding kidney involvement.
Purpose of the Study:
- To evaluate the long-term prognosis of hepatitis C virus-positive patients with mixed cryoglobulinemia.
- To compare outcomes between patients with and without kidney involvement.
Main Methods:
- 119 HCV-positive patients with MC were divided into two groups: without kidney involvement (Group A, 103 patients) and with glomerulonephritis (GN) (Group B, 16 patients).
- 37 patients with mesangio-proliferative glomerulonephritis (MPGN) served as controls (Group C).
- HCV RNA, genotype, and antibodies were determined. Liver, bone marrow, and kidney biopsies were performed as indicated.
Main Results:
- Group B patients (MC with GN) had poorer survival (50% at 5 years) compared to Group A (87.4%) and Group C (89.5%).
- Younger age, higher blood pressure, lower C4 levels, and poorer survival distinguished Group B from Group A.
- No patient in Group B developed kidney failure requiring dialysis; infections were the leading cause of death.
Conclusions:
- HCV-positive patients with MC and kidney involvement may represent a distinct syndrome (HCV-Risk syndrome).
- This syndrome is characterized by immune system impairment, lack of progression to kidney failure, and poor survival.
- Infections are a significant cause of mortality in this patient group.
Background:
The association between mixed cryoglobulinemia (MC) and hepatitis C virus (HCV) infection has been recently described in many reports.
Objective:
The aim of this study was to evaluate the long-term prognosis of hepatitis C virus-positive patients affected by mixed cryoglobulinemia with or without kidney involvement.
Patients:
At total of 119 hepatitis C virus-positive patients affected by mixed cryoglobulinemia were divided in two groups. Group A: mixed cryoglobulinemia without kidney involvement (103 cases); group B: mixed cryoglobulinemia with glomerulonephritis (GN) (16 cases). A further 37 patients affected by mesangio-proliferative glomerulonephritis (MPGN) were evaluated as controls (group C).
Methods:
Anti-hepatitis C virus antibodies were determined by commercial kits and hepatitis C virus-RNA was detected by polymerase chain reaction (PCR) amplification of the 5' untranslated region (5'UTR) of the virus. The hepatitis C virus genotype was determined according to Okamoto. Liver biopsy was performed in 62 patients, bone marrow biopsy in 65 patients, and kidney biopsy in all patients with proteinuria.
Results:
In group A, 46 patients (45%) were affected by chronic liver disease (CLD), 21 (20%) by low-grade non-Hodgkin's lymphoma (NHL) and 16 (15%) by both diseases. All patients of group B were affected by type I membrano-proliferative glomerulonephritis, 3 (19%) by chronic liver disease, 6 (37%) by low-grade non-Hodgkin's lymphoma, and 7 (44%) by both diseases. Several genotypes of hepatitis C virus were found, but Type 1b was prevalent. In group C, no patient showed chronic liver disease or non-Hodgkin's lymphoma. Younger age, higher mean blood pressure, lower C4 serum level, and poorer survival significantly distinguished group B from group A. Survival rates at 5 years were: 87.4% for group A, 89.5% for group C, and 50.0% for group B. None of the patients of group B developed kidney failure requiring dialysis, whilst infections were the leading cause of death.
Conclusions:
In hepatitis C virus-positive patients, the presence of mixed cryoglobulinemia associated with kidney involvement seems to indicate a new syndrome characterized by immune system impairment, lack of progression to kidney failure, and poor survival (hepatitis C virus-Risk syndrome).