Effect of antiviral therapy on hepatitis C virus related glomerulopathy

To determine the efficacy of antiviral therapy in hepatitis C virus associated glomerulopathy, we studied 30 patients with HCV-associated glomerulopathy at Sheikh Zayed Hospital, Lahore, Pakistan from June 2004 to February 2007. Membranoproliferative glomerulonephritis (MPGN) was the commonest kidney lesion, being reported in 25/30 (83%), followed by membranous glomerulonephritis (MGN) in 3/30 (10%) and mesangioproliferative glomerulonephritis (MesGN) in 2/30 (7%). Cryoglobulinaemia was positive in 8/20 (40%) cases. Most common HCV genotype was 3a. All the patients received interferon alpha combined with ribavirin therapy for 6-12 months based on viral genotypes and doses were adjusted according to renal function. Anti-viral response was achieved in the form of aviremia at completion of 6 months treatment in 8/30 (26.6%), decreased transaminases levels from a mean of 96.4 +/- 72.2 to 60.1 +/- 44.3 IU/L, p= 0.005, 24-hour proteinuria decreased significantly from a mean of 4.8 g to 1.20 g, p= 0.001, and complement C3 and C4 concentrations returned to normal in those subjects who responded to treatment. The rate of relapse was 50%. We conclude that though the overall antiviral response of HCV was not high, there was a significant reduction in proteinuria suggesting indirectly an improvement in renal pathology. Further studies with large number of patients with follow-up renal biopsies are warranted.