From the Guidelines
Hepatitis C infection is strongly associated with an increased risk of kidney disease, particularly in patients with chronic kidney disease (CKD) stage 4 or 5, and those on haemodialysis, and treatment with direct-acting antivirals such as glecaprevir/pibrentasvir is recommended to achieve viral clearance and potentially improve kidney function. The relationship between hepatitis and nephropathy is complex, with hepatitis C infection being a significant risk factor for the development of kidney disease, including glomerulonephritis and kidney failure. According to the EASL recommendations on treatment of hepatitis C 1, patients with CKD stage 4 or 5, including those on haemodialysis, should be treated with the fixed-dose combination of glecaprevir and pibrentasvir for 12 weeks, as it has been shown to be highly effective in achieving viral clearance, with an SVR12 rate of 98% in patients with CKD stage 4 or 5.
Some key points to consider in the management of hepatitis-associated nephropathy include:
- The use of direct-acting antivirals such as sofosbuvir/velpatasvir or glecaprevir/pibrentasvir to achieve viral clearance
- The importance of monitoring kidney function regularly through serum creatinine, estimated glomerular filtration rate, and urinalysis
- The potential benefits of treating hepatitis C infection in patients with CKD, including the potential to improve kidney function and reduce the risk of kidney failure
- The need to consider the optimal timing of treatment in patients on dialysis, including pre- or post-renal transplantation, and the potential risks and benefits of treatment in this population, as outlined in the KDIGO guideline on the prevention, diagnosis, evaluation, and treatment of hepatitis C virus infection in chronic kidney disease 2.
Overall, the treatment of hepatitis C infection in patients with kidney disease requires a comprehensive approach that takes into account the patient's underlying kidney function, the severity of their hepatitis C infection, and the potential risks and benefits of treatment. The use of direct-acting antivirals such as glecaprevir/pibrentasvir is a key component of this approach, and has been shown to be highly effective in achieving viral clearance and potentially improving kidney function.
From the Research
Relationship Between Hepatitis and Nephropathy
- Hepatitis B virus (HBV) infection has been associated with the development of nephropathy, particularly membranous nephropathy [ 3, 4, 5, 6 ]
- The underlying pathogenesis of hepatitis B-related glomerulonephritis (HBV-GN) involves immune complexes, which can be isolated from kidney tissues [ 3 ]
- Clearance of HBV antigenemia improves renal impairment and proteinuria in HBV-GN patients [ 3, 6 ]
Treatment of Hepatitis B-Associated Nephropathy
- Antiviral therapy is an effective treatment for HBV-associated nephropathy, with interferon and nucleoside analogs being equally effective at causing proteinuria remission and HBeAg clearance 4, 7, 5
- Novel nucleoside analogues, such as entecavir, adefovir, and clevudine, can be effective for treatment of HBV-associated nephropathy, including lamivudine-resistant strains 5
- Immunosuppression monotherapy, such as corticosteroids, is of little benefit and potentially harmful to HBV-GN patients due to the possibility of viral reactivation [ 3 ]