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Renal complications of liver diseases
Johan Noble1,2, Thomas Jouve1,2, Paolo Malvezzi1,2
1a Service de Néphrologie, Hémodialyse , Aphérèses et Transplantation rénale , Grenoble-Alpes , France.
Insights
Hepatitis B and C viruses can cause kidney disease through immune system responses and antibody deposits. While HBV and HCV infections are decreasing, their renal complications require ongoing management and research.
Area of Science:
- Nephrology
- Hepatology
- Immunology
Background:
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are leading causes of chronic liver disease, affecting 7% of the global population.
- Renal failure is a significant extra-hepatic complication of these viral infections, primarily driven by immune system dysregulation and antibody deposition in the kidneys.
- This review focuses on renal complications of viral hepatitis (HBV, HCV, HEV), autoimmune hepatitis, cirrhosis, and Wilson's disease, excluding hepatorenal syndrome.
Purpose of the Study:
- To review the spectrum of renal complications associated with various liver diseases, with a focus on viral hepatitis.
- To discuss the immunological mechanisms underlying kidney damage in these conditions.
- To provide an expert commentary on the future impact of vaccination and antiviral therapies on HBV- and HCV-related renal disorders.
Main Methods:
- Literature review of renal complications in viral hepatitis (HBV, HCV, HEV), autoimmune hepatitis, cirrhosis, and Wilson's disease.
- Analysis of immunological mechanisms and antibody deposition in kidney tissue.
- Expert commentary on epidemiological trends and therapeutic advancements.
Main Results:
- HBV and HCV infections are the most prevalent causes of viral hepatitis-associated renal disorders, including glomerulonephritis and polyarteritis nodosa.
- While HBV vaccination and direct-acting antivirals for HCV are expected to reduce associated renal complications, HCV-related cryoglobulinemia may persist post-eradication, requiring specific treatment.
- Hepatitis A and E viruses, though prevalent, are rarely linked to renal manifestations.
Conclusions:
- Renal complications are significant extra-hepatic manifestations of chronic liver diseases, particularly HBV and HCV infections.
- Advancements in vaccination and antiviral therapies are poised to decrease the burden of HBV- and HCV-related kidney disease.
- Ongoing vigilance and research are necessary to manage persistent or evolving renal complications, such as post-HCV cryoglobulinemia.
Introduction:
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major causes of chronic liver disease. HBV and HCV affect nearly 7% of the world's population. Extra-hepatic complications and particularly renal failure have different mechanisms and manifestations. The underlying mechanism, although differing for each disease, mainly involves the immune system and antibody deposits in the kidney, which can lead to tissue damage. Areas covered: We do not cover in this review hepatorenal syndrome. We report on the renal complications of viral hepatitis (HBV, HCV, hepatitis E), autoimmune hepatitis, cirrhosis, and Wilson's disease. The most frequent renal disorders are those related to HBV, and HCV due to their high prevalence worldwide. Expert commentary: Thanks to generalization of vaccination against HBV, prevalence of HBV-related liver diseases will decrease, and thereby its associated renal involvement such as polyarteritis nodosa (an exceptional condition), and glomerulonephritis such as membranous nephropathy. Thanks to direct acting antiviral agents HCV infection will be cured within the next decade. However, HCV-related cryoglobulinemia with or without renal involvement might evolve on its own after the patient has eliminated HCV, necessitating then rituximab therapy. Conversely, orofecal-transmitted hepatitis viruses such as hepatitis A and hepatitis E are still very prevalent in developing countries; however, they are rarely associated with renal manifestations.
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