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Published on: February 3, 2012
Multicenter study on hepatitis C virus-related cryoglobulinemic glomerulonephritis
Dario Roccatello1, Alessandro Fornasieri, Osvaldo Giachino
1Centro Universitario di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Ospedale S.G. Bosco, Torino, Italy. dario.roccatello@unito.it
Summary
Mixed cryoglobulinemia, often linked to hepatitis C virus (HCV), frequently impacts kidneys. Glomerulonephritis prognosis is improved by modern therapies, with cardiovascular events now the leading cause of death.
Area of Science:
- Nephrology
- Immunology
- Hepatology
Background:
- Mixed cryoglobulinemia is a multisystem vasculitic disorder strongly associated with hepatitis C virus (HCV) infection.
- Renal involvement, specifically glomerulonephritis, is common and significantly impacts patient prognosis.
Purpose of the Study:
- To analyze clinical, serological, immunogenetic, and morphological data in patients with cryoglobulinemic glomerulonephritis.
- To identify prognostic factors and assess survival in a large cohort of patients with cryoglobulinemic glomerulonephritis.
Main Methods:
- Retrospective collection of data from 146 patients with cryoglobulinemic glomerulonephritis and 34 controls without renal involvement across 25 Italian centers.
- Utilized multivariate Cox proportional hazard models to determine independent predictors of severe renal failure.
Main Results:
- Hepatitis C virus (HCV) infection was present in 87% of patients, with genotype 1b being most common.
- Diffuse membranoproliferative glomerulonephritis (83%) and type II cryoglobulin (74.4%) were the predominant histological and cryoglobulin patterns, respectively.
- Age, serum creatinine, and proteinuria independently predicted severe renal failure; 10-year survival was approximately 80%, with cardiovascular disease causing over 60% of deaths.
Conclusions:
- Confirms the strong association between mixed cryoglobulinemia, HCV, and glomerulonephritis, particularly type II cryoglobulin.
- Survival rates have improved, likely due to enhanced therapeutic regimens, shifting mortality causes from infections/hepatic failure to cardiovascular events.
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