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Membranous glomerulonephritis associated with hepatitis C virus infection in renal transplant patients
J M Morales1, J Pascual-Capdevila, J M Campistol
1Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Background:
Hepatitis C virus (HCV) infection has been described in association with various types of glomerular diseases, usually type I membranoproliferative glomerulonephritis and rarely membranous glomerulonephritis (MGN). In this article, we describe the first series of MGN exhibited in renal transplant patients and associated with HCV infection.
Methods:
From January 1980 to December 1994, 2045 kidney transplantations were performed in our renal transplant units. A retrospective analysis demonstrated an overall 20% prevalence of HCV virus-positive patients; 409 transplanted patients were HCV positive (ELISA and RIBA).
Results:
Fifteen patients developed an allograft MGN (3.66%) 24 months after renal transplantation. MGN appeared in the form of significant proteinuria (>1.5 g/24 h) with stable renal function. In all cases, graft biopsy demonstrated a thickening of the capillary wall, subepithelial electron-dense deposits, and IgG and C3 diffuse granular deposits along the basal membrane. Ten cases were considered de novo, two cases were considered recurrent MGN, and three cases were considered undetermined because the primary renal disease was chronic glomerulonephritis. All patients showed negative antinuclear antibodies and cryoglobulins, normal complement, and negative rheumatoid factors. During follow-up (an average of 2 years), 12 patients developed a progressive worsening of renal function, with increased serum creatinine and persistent proteinuria; 8 of the 12 patients returned to dialysis. Of the remaining three cases, two patients showed partial remission of nephrotic syndrome after high doses of steroids, and one patient persisted with stable renal function and proteinuria (<2 g/24 h.).
Conclusions:
In summary, HCV is preferentially associated with MGN in renal transplant patients, rather than with membranoproliferative glomerulonephritis as in the normal adult population. MGN associated with HCV infection has a similar clinical picture and outcome to posttransplant idiopathic de novo MGN, with persistent massive proteinuria and progressive deterioration of renal function.
Insights
Hepatitis C virus (HCV) infection is linked to membranous glomerulonephritis (MGN) in kidney transplant recipients. This condition often presents with proteinuria and can lead to worsening kidney function, with many patients requiring dialysis.
Area of Science:
- Nephrology
- Transplantation Immunology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection is associated with glomerular diseases, primarily membranoproliferative glomerulonephritis and less commonly membranous glomerulonephritis (MGN).
- This study investigates the first series of MGN cases in renal transplant recipients specifically linked to HCV infection.
Purpose of the Study:
- To describe the characteristics and outcomes of membranous glomerulonephritis (MGN) in renal transplant patients with Hepatitis C virus (HCV) infection.
- To determine the prevalence and clinical course of HCV-associated MGN in a transplant population.
Main Methods:
- Retrospective analysis of 2045 kidney transplantations performed between January 1980 and December 1994.
- Identified 409 (20%) HCV-positive patients and analyzed the incidence of de novo or recurrent allograft MGN.
Main Results:
- Fifteen patients (3.66%) developed allograft MGN post-transplant, characterized by proteinuria and specific biopsy findings (capillary wall thickening, subepithelial deposits).
- HCV-associated MGN presented similarly to idiopathic de novo MGN, with persistent proteinuria and progressive renal function decline in most cases; 8 of 12 patients with worsening function returned to dialysis.
- A small subset experienced partial remission with steroids or maintained stable function.
Conclusions:
- Hepatitis C virus (HCV) is preferentially associated with membranous glomerulonephritis (MGN) in renal transplant recipients, unlike the general population where it's linked to membranoproliferative glomerulonephritis.
- HCV-associated MGN in transplant patients shares a similar clinical presentation and prognosis with idiopathic de novo MGN, marked by significant proteinuria and deteriorating renal function.