Tubular cell damage may be the earliest sign of renal extrahepatic manifestation caused by Hepatitis C.

Kati Kaartinen,Eliisa Löyttyniemi,Sauli Vuoti,Ravinder Singh,Martti Färkkilä,Eero Honkanen,Chen-Hua Liu

doi:10.1371/journal.pone.0251392

Kati Kaartinen, Eliisa Löyttyniemi + Show 5 more

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https://doi.org/10.1371/journal.pone.0251392

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Abstract

Chronic kidney disease (CKD) is one of the most well-known extrahepatic manifestations caused by hepatitis C infection (HCV). CKD is typically discovered at a late stage. HCV-nephropathy may show different histopathologic patterns, as both glomerular and tubulointerstitial damage have been described. Identification of patients with early renal manifestations would be beneficial to provide treatment and avoid progression to CKD. The observational prospective single-center HCVKID study assessed the prevalence of early renal manifestations in patients with chronic HCV and compared these patients with HCV-negative healthy controls cross-sectionally. HCV-positive patients with and without renal manifestations were also compared to define biomarkers suitable for identifying early manifestations in standard clinical practice. Tubular proteinuria as judged by urine α 1-microglobulin was the most common early renal manifestation found in 11% in HCV-positive patients, followed by hematuria in 8%. Kidney filtration was statistically significantly lower among HCV-positive patients with renal manifestation according to any calculation method. There were no significant differences in duration of infection or stage of liver fibrosis between patients with or without renal manifestations. Tubular cell damage may be the earliest sign of renal dysfunction caused by HCV. Complement activation also correlates with the dysfunction, indicating of contribution to HCV-induced renal manifestations even in their early phase.

Highlights

Hepatitis C [HCV] infection is known to cause kidney manifestations, which are typically discovered at a late stage when chronic kidney disease (CKD) has already emerged [1,2,3]
An HCVpositive patient was considered to have a renal manifestation if his or her s-creatinine was above the upper normal limit or if his or her estimated glomerular filtration rate calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was below the normal limit (< 60 ml/min/ 1.73 m2)
The HCV-negative controls were considered to have renal impairment if their s-creatinine was above the upper normal limit or if their estimated glomerular filtration rate (eGFR) calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation fell below the normal limit (< 60 ml/min/ 1.73 m2)

Summary

Introduction

Hepatitis C [HCV] infection is known to cause kidney manifestations, which are typically discovered at a late stage when chronic kidney disease (CKD) has already emerged [1,2,3]. HCV is both a consequence and cause of renal impairment: first, dialysis patients have an increased infection risk related to medical procedures and, second, HCV causes pathological changes to the kidneys [1, 4, 5]. Ravinder Singh is an ex-employee of MSD Norway

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