Sofosbuvir and daclatasvir induced acute kidney injury in patient with hepatitis C related decompensated cirrhosis

Abstract

A 62-year-old female with hepatitis C and decompensated cirrhosis received oral sofosbuvir 400 mg and daclatasvir 60 mg once daily. She developed edema of lower extremities about 18 weeks after beginning antiviral drugs. Two weeks later, the patient developed edema of face. Laboratory tests revealed the following results: serum creatinine 91 μmol/L, eGFR 54 ml/(min·1.73 m2), serum β2 microglobulin 4.42 mg/L, 24-hour urine protein 0.394 g. She received treatments including diuretic and liver protection. Sofosbuvir and daclatasvir was continued at the same dose as before. Eight days later, the edema of the face and lower extremities were further aggravated with decreased urine volume. Serum creatinine increased to 124 μmol/L, eGFR decreased to 37 ml/(min·1.73 m2), and serum β2 microglobulin was 5.06 mg/L. She received an IV infusions of human albumin. Two weeks later, the serum creatinine increased to 220 μmol/L, eGFR decreased to 19 ml/(min·1.73 m2), and 24-hour urine protein was 0.417 g. Acute kidney injury was diagnosed. Sofosbuvir and daclatasvir were withdrawn. An IV infusion of terlipressin 1 mg twice daily was given. After 3 days of discontinuation of sofosbuvir and daclatasvir, the edema of face was basically subsided, edema of lower extremities significantly subsided, serum creatinine decreased to 97 μmol/L, eGFR increased to 50 ml/(min·1.73 m2), and 24-hour urine protein was 0.398 g. After 8 weeks, the edema of lower extremities disappeared completely, serum creatinine was 64 μmol/L and eGFR was 85 ml/(min·1.73 m2) . Key words: Acute kidney injury; Sofosbuvir; Daclatasvir