Hepatitis C virus-associated membranoproliferative glomerulonephritis in renal allografts.

Abstract

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.

• Authors: J M Cruzado, S Gil-Vernet, G Ercilla, D Seron, M Carrera, J Bas, J Torras, J Alsina, J M Grinyó
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 7 Issue 11 Pg. 2469-75 (Nov 1996) ISSN: 1046-6673 [Print] United States
• PMID: 8959641 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cryoglobulins
• Hepatitis C Antibodies
• RNA, Viral

Topics

• Adult
• Aged
• Biopsy
• Cryoglobulinemia (metabolism, pathology, virology)
• Cryoglobulins (metabolism)
• Glomerulonephritis, Membranoproliferative (metabolism, pathology, virology)
• Graft Rejection (etiology, immunology, pathology)
• Hepacivirus (genetics, immunology)
• Hepatitis C (complications, metabolism, pathology)
• Hepatitis C Antibodies (analysis)
• Humans
• Kidney Transplantation (immunology, pathology)
• Middle Aged
• Polymerase Chain Reaction
• RNA, Viral (analysis)
• Radioimmunoassay
• Retrospective Studies
• Transplantation, Homologous