Hepatitis C virus (HCV) and chronic renal disease

Recent epidemiological evidence suggests an association between HCV infections and immunologically mediated renal disease. A high seroprevalence of anti-HCV has been observed in patients with glomerulonephritis in several countries including, Japan, Italy, America and Spain. However, a study in France did not show such association but increased seroprevalence of anti-HCV has been reported in patients with end-stage renal disease (ESRD) on chronic haemodialysis when compared with normal population suggesting that dialysis patients might be at higher risk of acquiring this infection. Anti-HCV seroprevalence has been found to increase with the duration of dialysis and the number of units of blood transfused raising the possibility of both transfusion and nosocomial transmission of HCV. A greater seroprevalence of anti-HCV has also been reported in predialytic chronic renal failure (CRF) patients independent of blood transfusion when compared with patients without renal disease and the normal population. The mechanism underlying hepatitis C induced renal damage is not certain. However, most evidence suggests that glomerular injury results from the deposition of circulating immune complexes (CICs) containing hepatitis C antibodies, hepatitis C antigens and complement mainly C3 within the sub-endothelium and mesangium. The optimal treatment strategy for hepatitis C-associated renal diseases remains to be defined but treatment has been associated with improvement in the level of proteinuria and variable response in serum creatinine levels using some antiviral agents.