Hepatitis C-related membranoproliferative glomerulonephritis in the era of direct antiviral agents

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Walid Ahmed Ragab Abdelhamid1, Ali Shendi1, Mahmoud Zahran1

  • 1Zagazig University, Faculty of Medicine, Internal Medicine Department, Zagazig, Egypt.

Jornal Brasileiro De Nefrologia
|February 19, 2021
PubMed

Insights

Direct-acting antivirals (DAA) show promise for Hepatitis C virus (HCV)-related membranoproliferative glomerulonephritis (MPGN), but patients may remain immunosuppression-dependent post-treatment. Renal response can lag behind viral response in these complex cases.

Area of Science:

  • Nephrology
  • Hepatology
  • Virology

Background:

  • Membranoproliferative glomerulonephritis (MPGN) is frequently associated with Hepatitis C virus (HCV).
  • Limited data exists on direct-acting antiviral (DAA) efficacy in HCV-associated glomerulonephritis.
  • HCV-related MPGN can manifest with or without cryoglobulinemia.

Purpose of the Study:

  • To evaluate renal and viral response in two cases of HCV-related MPGN treated with DAAs.
  • To assess the impact of DAA therapy on immunosuppression requirements in HCV-related MPGN.
  • To investigate the relationship between virological and renal response following DAA treatment.

Main Methods:

  • Case study analysis of two patients with HCV-related MPGN (one cryoglobulinemic, one cryoglobulin-negative).
  • Treatment involved direct-acting antivirals (DAA) combined with immunosuppression.
  • Assessment of renal function, viral load, and immunosuppression dependence post-DAA therapy.

Main Results:

  • Both patients achieved partial remission with DAA and immunosuppression.
  • Sustained virological response was observed, but immunosuppression dependence persisted for over 6 months.
  • Incomplete immunosuppression withdrawal was necessary despite negative occult HCV testing in peripheral blood mononuclear cells.

Conclusions:

  • Treatment for HCV-related MPGN should be individualized based on clinical status and drug response.
  • Renal recovery may lag significantly behind viral clearance after DAA therapy.
  • HCV-related MPGN management requires careful consideration of ongoing immunosuppression needs.

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