Figure 714

Glomerular disease in HCV positive recipients. Chronic hepatitis C virus (HCV) infection has been associated with several different immune-complex-mediated diseases in the renal allograft, including membranous and membranoproliferative glomerulonephritis (MPGN)

[102-106]. From a cohort of 98 renal allograft recipients with HCV, Roth and colleagues [105] detected de novo membranoproliferative glomerulonephritis in the biopsies of five of eight patients with pro-teinuria of over 1 g/24 h [105]. Compared with a control group of nonproteinuric kidney recipients infected with HCV, patients with MPGN had viral particles present in greater amounts in the high-density fractions of sucrose density gradients associated with significant amounts of IgG and IgM. Thus, deposition of immune complexes containing HCV genomic material may be involved in the pathogenesis of this form of MPGN. The differential diagnosis for significant proteinuria in a patient infected with HCV after transplantation should include immune-complex glomerulonephritis. Similarly, if the renal allograft biopsy shows immune-complex glomerulonephritis, the patient should be tested for HCV infection without regard to serum alanine amino-transferase levels.

0 0

Post a comment