Membranoproliferative glomerulonephritis associated with hepatitis C virus infection.
The hepatitis C virus genome has been recently sequenced and cloned, allowing the identification of patients exposed to this virus, which is now felt to be the principal cause of "non-A, non-B" hepatitis. The hepatitis B virus has long been implicated in the pathogenesis of several glomerulopathies including membranoproliferative glomerulonephritis, mixed cryoglobulinemia, and membranous glomerulonephritis. Several authors have recently reported an association between hepatitis C virus infection and glomerular disease. The case of a patient with chronic hepatitis C virus infection who developed the nephrotic syndrome 3 months after liver transplantation is described. Serologic testing was significant for an elevated rheumatoid factor, circulating cryoglobulins, and a mildly depressed C4 level. Hepatitis C virus antibody and viral RNA (by polymerase chain reaction) were present in both the serum and cryoglobulin fraction. A renal biopsy demonstrated membranoproliferative glomerulonephritis. It is believed that persistent infection with the hepatitis C virus is responsible for an immune complex-mediated glomerulonephritis in this patient. Because hepatitis C has now been pathogenetically linked to several glomerulopathies, testing for this virus should be considered in the serologic work-up of the patient with glomerulonephritis.
Burstein
D M
DM
Department of Medicine, Rush Medical College, Chicago, Illinois.
Rodby
R A
RA
D000368:Aged; D003449:Cryoglobulinemia / Q000209:etiology; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000209:etiology* / Q000473:pathology; D016174:Hepacivirus / Q000276:immunology / Q000302:isolation & purification; D006508:Hepatitis Antibodies / Q000097:blood; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications* / Q000601:surgery; D018937:Hepatitis C Antibodies; D006521:Hepatitis, Chronic / Q000150:complications* / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects; D009404:Nephrotic Syndrome / Q000209:etiology; D012367:RNA, Viral / Q000097:blood
D006508:Hepatitis Antibodies; D018937:Hepatitis C Antibodies; D012367:RNA, Viral