Abstract |
Chronic hepatitis C virus (HCV) infection is associated with numerous extra-hepatic complications, including neurological and renal manifestations. We describe the case of a 67-year-old Caucasian man with HCV-associated cryoglobulinemic glomerulonephritis, cirrhosis, and hepatocellular carcinoma. The early posttransplant course was complicated by fibrosing cholestatic hepatitis due to recurrent HCV in the graft (HCV RNA up to 44,944,438 IU/mL). Proliferative glomerulonephritis (nephritic and nephrotic syndrome) with mixed cryoglobulinemia ( purpura) was also recorded. Seventy-two days after surgery, the patient presented with seizures and arterial hypertension; brain magnetic resonance imaging indicated the diagnosis of posterior reversible encephalopathy syndrome (PRES). PRES responded well to medical treatment with complete resolution of neurological changes. Antiviral therapy ( sofosbuvir and ribavirin, six months) gave a sustained viral response with the improvement of cryoglobulinemic symptoms (including glomerular disease). Repeat liver biopsy revealed the regression of cholestatic damage and perisinusoidal fibrosis. The current follow-up shows stable chronic renal failure (serum creatinine: 1.4 mg/dL) and mild nephritic syndrome. The impact of extrahepatic manifestations of HCV on patient outcomes is highlighted from novel observational studies reporting a relationship between HCV cure (as expressed by the sustained viral response) and a decrease in both liver-related and renal complications. Clinical trials evaluating the efficacy and tolerance of novel direct-acting antiviral agents for the management of HCV-associated glomerular diseases are underway.
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Authors | Fabrizio Fabrizi, Aldo Paolucci, Barbara Antonelli, Roberta Cerutti, Francesca Maria Donato, Pietro Lampertico, Piergiorgio Messa |
Journal | Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
(Saudi J Kidney Dis Transpl)
2019 Jan-Feb
Vol. 30
Issue 1
Pg. 239-249
ISSN: 1319-2442 [Print] Saudi Arabia |
PMID | 30804289
(Publication Type: Case Reports, Journal Article, Review)
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Chemical References |
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Topics |
- Adult
- Aged
- Antiviral Agents
(therapeutic use)
- Brain
(pathology)
- Cryoglobulinemia
- Glomerulonephritis
- Hepatitis C, Chronic
(complications, drug therapy)
- Humans
- Liver Transplantation
(adverse effects)
- Male
- Middle Aged
- Posterior Leukoencephalopathy Syndrome
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