Journal of the American Society of Nephrology, Vol 7, 2469-2475, Copyright © 1996 by American Society of Nephrology

REGULAR ARTICLES

Hepatitis C virus-associated membranoproliferative glomerulonephritis in renal allografts

JM Cruzado, S Gil-Vernet, G Ercilla, D Seron, M Carrera, J Bas, J Torras, J Alsina and JM Grinyo
Department of Nephrology, Ciutat Sanitaria i Universitaria de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.

In renal transplantation, chronic allograft nephropathy is the leading cause of long-term graft losses, transplant glomerulopathy being its glomerular form. Differential diagnosis from recurrent or de novo membranoproliferative glomerulonephritis should be established. Whether hepatitis C virus is associated with cryoglobulinemia and glomerular damage in renal allograft recipients, as in native kidneys, is not known. We identified six hepatitis C virus-infected renal allograft recipients with proteinuria higher than 1.5 g/day, microhematuria, and membranoproliferative glomerulonephritis. Virologic and immunologic studies were conducted. Low serum levels of circulating immune complexes and cryoglobulins were observed, which were type II immunoglobulin G polyclonal-immunoglobulin Mk monoclonal in all six patients. Classical serum complement pathway activation and at least one type of autoantibodies were present in all of them. Hepatitis C virus RNA was found in higher concentrations in cryoprecipitate than in serum (percentage of enrichment ranged from 341 to 18,200%). Hepatitis C virus genotype was 1b in 4 of 6 patients, 1a in 1 of 6 patients, and 2a in 1 of 6 patients. In renal histology prominent parietal diffuse deposition of immunoglobulin M was the rule. Glomerular subendothelial electron-dense deposits with fibrillar appearance were observed in the two patients in which electron microscopy provided information about glomeruli. In renal allograft recipients hepatitis C virus infection may be associated with type II cryoglobulinemia which may lead to membranoproliferative glomerulonephritis. Immunologic and virologic studies may help to differentiate hepatitis C virus-associated membranoproliferative glomerulonephritis from transplant glomerulopathy.

This article has been cited by other articles:

				N. A. Terrault and D. B. Adey The Kidney Transplant Recipient with Hepatitis C Infection: Pre- and Posttransplantation Treatment Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 563 - 575. [Abstract] [Full Text] [PDF]

				O. Bestard, J. M. Cruzado, G. Ercilla, M. Goma, J. Torras, D. Seron, I. Rama, M. Ibernon, O. Vinas, M. Carrera, et al. Rituximab induces regression of hepatitis C virus-related membranoproliferative glomerulonephritis in a renal allograft Nephrol. Dial. Transplant., August 1, 2006; 21(8): 2320 - 2324. [Full Text] [PDF]

				A. Djamali, M. Samaniego, B. Muth, R. Muehrer, R. M. Hofmann, J. Pirsch, A. Howard, G. Mourad, and B. N. Becker Medical Care of Kidney Transplant Recipients after the First Posttransplant Year Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 623 - 640. [Abstract] [Full Text] [PDF]

				J. M. Cruzado, E. M. Briganti, R. C. Atkins, S. J. Chadban, and the Australia and New Zealand Dialysis and Transpl Recurrent Glomerulonephritis and Risk of Renal Allograft Loss N. Engl. J. Med., November 7, 2002; 347(19): 1531 - 1532. [Full Text] [PDF]

				B. L. KASISKE, M. A. VAZQUEZ, W. E. HARMON, R. S. BROWN, G. M. DANOVITCH, R. S. GASTON, D. ROTH, J. D. SCANDLING JR., and G. G. SINGER Recommendations for the Outpatient Surveillance of Renal Transplant Recipients J. Am. Soc. Nephrol., October 1, 2000; 11(2007): S1 - S86. [Abstract] [Full Text] [PDF]

				J. M. MORALES and J. M. CAMPISTOL Transplantation in the Patient with Hepatitis C J. Am. Soc. Nephrol., July 1, 2000; 11(7): 1343 - 1353. [Full Text]

				M. A. Gentil, J. L. Rocha, G. Rodriguez-Algarra, P. Pereira, R. Lopez, G. Bernal, J. Munoz, M. Naranjo, and J. Mateos Impaired kidney transplant survival in patients with antibodies to hepatitis C virus Nephrol. Dial. Transplant., October 1, 1999; 14(10): 2455 - 2460. [Abstract] [Full Text] [PDF]

				J. M. Cruzado, J. Torras, J. Dominguez, C. Sancho, J. Alsina, and J. M. Grinyo An unusual cause of post-biopsy oliguria in an allograft Nephrol. Dial. Transplant., August 1, 1999; 14(8): 2022 - 2024. [Full Text] [PDF]

				S. BAID, M. PASCUAL, W. W. WILLIAMS JR., N. TOLKOFF-RUBIN, S. M. JOHNSON, B. COLLINS, R. T. CHUNG, F. L. DELMONICO, A. B. COSIMI, and R. B. COLVIN Renal Thrombotic Microangiopathy Associated with Anticardiolipin Antibodies in Hepatitis C-Positive Renal Allograft Recipients J. Am. Soc. Nephrol., January 1, 1999; 10(1): 146 - 153. [Abstract] [Full Text]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673