Nephrology Dialysis Transplantation, Vol 13, Issue 8 1991-1997, Copyright © 1998 by Oxford University Press
F Fabrizi, C Pozzi, M Farina, P Dattolo, G Lunghi, S Badalamenti, A Pagano and F Locatelli
Background. The relationship between hepatitis C virus
(HCV) infection and acute or chronic glomerulonephritis (GN) is not well
understood. Methods. Two hundred and eighty-four
patients with biopsy-proven GN and other renal diseases were studied in a
multicentre survey performed during the period 1992-1995. Several clinical
parameters were collected for each patient at the time of renal biopsy. We
made a multivariate analysis by logistic regression model to evaluate the
independent association of clinical and histological patient
characteristics with HCV infection, as detected by anti-HCV antibody
testing. In addition, three patients with HCV-related liver disease;
membranous nephropathy, and proteinuria in the nephrotic range received
therapy with interferon-alpha in standard doses.
Results. The prevalence of anti-HCV positivity was 13%
(38/284). The frequency of anti-HCV positivity ranged between 0 and 100% in
the different types of renal diseases, the difference was statistically
significant (P = 0.0001). The anti-HCV rate was
significantly higher in patients with cryoglobulinaemic
membrano-proliferative and mesangioproliferative GN than among the other
individuals (14/14 (100%) vs 24/270 (9%),
P = 0.0002). Our multivariate analysis by logistic
regression model showed that age (P = 0.0017) and type
of renal diseases (P = 0.0007) were independently and
significantly associated with anti-HCV antibody. At the completion of
treatment with interferon-alpha, 67% (2/3) of patients with membranous
nephropathy had lowering of hepatic enzyme levels into the normal range
whereas 100% (3/3) of these did not show significant reduction of
proteinuria. Conclusions. We observed strong
association between HCV infection and cryoglobulinaemic GN. Age and type of
renal disease were important independent predictors of anti-HCV positivity
in our cohort of patients. Three anti-HCV-positive patients with membranous
nephropathy did not show significant remission of nephrotic proteinuria
after treatment with interferon-alpha. Our data do not appear to support an
association between HCV and non-cryoglobulinaemic GN. Further
epidemiological surveys, experimental studies and clinical trials are
warranted to fully elucidate the role of HCV in non-cryoglobulinaemic GN.
Keywords: HCV; cryoglobulinaemic and
non-cryoglobulinaemic glomerulonephritis; interferon therapy
ORIGINAL ARTICLES
Hepatitis C virus infection and acute or chronic glomerulonephritis: an epidemiological and clinical appraisal
Nephrology and Dialysis Units of Lecco, Lodi, Florence, and Milan Hospitals, Italy; The Institute of Hygiene and Preventive Medicine, University of Milan, Milan, Italy; Correspondence to: F Fabrizi, Division of Nephrology and Dialysis, Lecco Hospital, Via Ghislanzoni 22, I-22053 Lecco, Italy
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