HCV cirrhotic patients treated with direct-acting antivirals: Detection of tubular dysfunction and resolution after
Elisa Biliotti1, Donatella Palazzo1, Francesca Tinti2
1Hepatology Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Insights
Hepatitis C virus (HCV) infection causes kidney tubular dysfunction in cirrhotic patients. Clearance of HCV significantly improves tubular function, but it may persist in some cases.
Area of Science:
- Nephrology
- Hepatology
- Virology
Background:
- Hepatitis C virus (HCV) infects kidney tubular cells, but its impact on tubular function in vivo is unknown.
- Tubular dysfunction is a risk factor for chronic kidney disease (CKD).
Purpose of the Study:
- To determine the prevalence and evolution of kidney tubular dysfunction in cirrhotic patients with HCV infection.
- To assess the impact of HCV clearance on tubular and glomerular damage.
Main Methods:
- Prospective longitudinal study of 135 Child-Pugh A cirrhotic patients before and 6 months after antiviral therapy.
- Tubular dysfunction assessed by urinary alpha1-microglobulin to creatinine ratio (α1-MCR).
- Glomerular damage assessed by urinary albumin to creatinine ratio (ACR).
Main Results:
- Tubular dysfunction was present in 23.7% of patients, often co-occurring with glomerular damage.
- Glomerular damage, diabetes, and hypertension predicted tubular dysfunction.
- HCV clearance led to a significant reduction in α1-MCR, with 57.1% of patients showing resolved tubular dysfunction.
Conclusions:
- Tubular dysfunction is an unrecognized feature of HCV-related kidney disease in cirrhotic patients.
- Investigate tubular dysfunction in patients with glomerular damage, diabetes, and hypertension, even with normal e-GFR.
- While HCV clearance improves tubular function, its long-term impact requires further study.
Background/Aims:
Hepatitis C virus (HCV) has been identified in tubular epithelial cells of infected patients; however, the presence of tubular dysfunction, which is a risk factor for chronic kidney disease (CKD), has never been examined in vivo. The present prospective longitudinal study aimed to estimate the prevalence of tubular dysfunction alone or with glomerular damage and its evolution after HCV clearance in cirrhotic patients.
Methods:
One hundred and thirty-five consecutive Child-Pugh A cirrhotic patients were evaluated before antiviral treatment and 6 months after the end of therapy. Tubular dysfunction was evaluated by urinary alpha1-microglobulin to creatinine ratio (α1-MCR), and glomerular damage was assessed by urinary albumin to creatinine ratio (ACR).
Results:
Almost all the patients (93.3%) showed a normal or mildly decreased e-GFR (KDIGO-G1/G2-categories). Tubular dysfunction was found in 23.7% (32/135) of patients, co-occurring with glomerular damage in 37.5% (12/32) of cases, while glomerular damage was found in 16.3% (22/135) of patients. In multiple logistic regression, glomerular damage and the concomitant presence of diabetes and hypertension were the only predictors significantly associated with tubular dysfunction. After HCV clearance, patients experienced a significant reduction of α1-MCR levels (21.0 vs 10.5 μg/mg, P = .009) and tubular dysfunction resolved in 57.1% of subjects.
Conclusions:
Tubular dysfunction is an unrecognized feature of HCV-related kidney disease in cirrhotic patients and its presence should be primarily investigated in subjects with glomerular damage, diabetes and hypertension, despite normal e-GFR. Tubular dysfunction resolves in the majority of cases after HCV clearance; however, it may persist after antiviral treatment and further studies should evaluate its long-term impact on kidney function.
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