What are the viral causes of renal (kidney) and hepatic (liver) failure?

From the Guidelines

Viral infections, particularly hepatitis B and C, are major causes of both renal and hepatic failure, and direct-acting antivirals (DAAs) like glecaprevir and pibrentasvir have shown high efficacy and safety in treating hepatitis C in patients with renal impairment, including those on haemodialysis 1.

Viral Causes of Renal Failure

• Hepatitis B and C viruses can lead to glomerulonephritis and membranoproliferative glomerulonephritis
• HIV can cause HIV-associated nephropathy (HIVAN), characterized by collapsing focal segmental glomerulosclerosis
• Hantavirus causes hemorrhagic fever with renal syndrome
• Cytomegalovirus (CMV) and BK virus primarily affect immunocompromised patients, particularly transplant recipients

Viral Causes of Hepatic Failure

• Hepatitis viruses A through E are the primary culprits, with hepatitis B and C causing chronic infection that may progress to cirrhosis and liver failure
• Hepatitis A and E typically cause acute self-limiting disease but can occasionally lead to fulminant hepatic failure
• Other viruses like Epstein-Barr virus, herpes simplex virus, and adenovirus can cause hepatitis, especially in immunocompromised hosts

Treatment and Prevention

• Treatment depends on the specific virus and includes antivirals like entecavir or tenofovir for hepatitis B, direct-acting antivirals for hepatitis C, and supportive care
• Prevention through vaccination is available for hepatitis A and B, while good hygiene practices help prevent hepatitis A and E transmission
• Early diagnosis through serological testing and viral load measurement is crucial for effective management of these conditions
• The fixed-dose combination of glecaprevir and pibrentasvir is the treatment of choice for patients with chronic hepatitis C and stage 4 or 5 CKD (including those on haemodialysis) 1
• Sofosbuvir-based regimens have also been reported to be safe and effective in patients with severe CKD, including patients on haemodialysis 1

From the FDA Drug Label

Hepatitis B virus reactivation: Before starting treatment with ledipasvir and sofosbuvir, your healthcare provider will do blood tests to check for hepatitis B virus infection If you have ever had hepatitis B virus infection, the hepatitis B virus could become active again during or after treatment of hepatitis C virus with ledipasvir and sofosbuvir. Hepatitis B virus becoming active again (called reactivation) may cause serious liver problems including liver failure and death

• Viral causes of renal and hepatic failure include Hepatitis B virus.
• The Hepatitis B virus can reactivate during or after treatment with ledipasvir and sofosbuvir, leading to serious liver problems, including liver failure.
• Patients with a history of Hepatitis B virus infection are at risk for reactivation and should be monitored by their healthcare provider during and after treatment with ledipasvir and sofosbuvir 2.

From the Research

Viral Causes of Renal and Hepatic Failure

• Hepatitis B virus (HBV) is a major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma, which can lead to hepatic failure 3.
• HBV can also cause renal failure, particularly in patients with pre-existing kidney disease 4.
• Other viral infections, such as hepatitis A, C, and E, can also cause acute liver failure, which can lead to renal failure in severe cases 5.
• The use of antiviral agents, such as entecavir and tenofovir, can help prevent the progression of HBV-related liver disease and reduce the risk of renal failure 6, 7.

Treatment Options

• Entecavir and tenofovir are effective antiviral agents for the treatment of chronic hepatitis B, with high potency and low rates of resistance 3, 6.
• The combination of entecavir and tenofovir can provide a rescue regimen for patients who have failed previous nucleos(t)ide analog therapy 6.
• Tenofovir alafenamide is also an effective antiviral agent for the treatment of chronic hepatitis B, with similar efficacy to entecavir and tenofovir disoproxil fumarate 7.

Epidemiology

• Hepatitis E virus is the most common cause of viral-induced acute liver failure, particularly in low-income and middle-income countries 5.
• Hepatitis A and B viruses are also significant causes of acute liver failure, particularly in areas with low vaccination rates 5.
• The burden of viral-induced acute liver failure is higher in countries with poor economic status and limited resources for managing acute liver failure 5.