Exacerbation of glomerulonephritis in subjects with chronic hepatitis C virus infection after interferon therapy.
We previously reported the glomerular deposition of hepatitis C virus (HCV) core antigen (Ag) in HCV-related nephropathy. In this study, we analyzed 23 HCV-positive subjects with exacerbation of proteinuria and/or hematuria during interferon (IFN) therapy and measured urinary protein selectivity. We also examined the involvement of HCV-related Ag using anti-HCV core (capside) Ag murine monoclonal antibody (Ab) and anti-core2 rabbit polyclonal Abs in nine subjects. Of 17 subjects, 13 (78%) showed low selective proteinuria. We found mesangial proliferative glomerulonephritis in 9 subjects, membranoproliferative glomerulonephritis in 1 subject, and nephrosclerosis in 1 subject. Immunofluorescence study showed the glomerular deposition of immunoglobulin G (IgG) or IgA and complements in all 9 subjects examined. Trace amounts only of HCV core Ag were detected along the glomerular capillary wall in 3 of 9 subjects (33%). Electron microscopy showed subendothelial or mesangial electron-dense deposits and also foot process effacement (20% to 72.5% of glomerular capillary walls) in all subjects and endothelial swelling in 4 subjects. In conclusion, IFN therapy for HCV may exacerbate the underlying glomerulopathies, unrelated to HCV Ags, through direct or indirect effects on glomerular endothelial and epithelial cells. Physicians should carefully distinguish HCV-related nephropathy from other glomerular diseases when they administer IFN therapy to HCV-positive subjects.
Ohta
S
S
Division of Blood Purification, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Yokoyama
H
H
Wada
T
T
Sakai
N
N
Shimizu
M
M
Kato
T
T
Furuichi
K
K
Segawa
C
C
Hisada
Y
Y
Kobayashi
K
K
D000328:Adult; D000911:Antibodies, Monoclonal; D005260:Female; D005455:Fluorescent Antibody Technique; D005921:Glomerulonephritis / Q000150:complications* / Q000473:pathology; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications; D018936:Hepatitis C Antigens / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007372:Interferons / Q000009:adverse effects*; D007678:Kidney Glomerulus / Q000648:ultrastructure; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications; D011507:Proteinuria / Q000209:etiology; D014758:Viral Core Proteins / Q000032:analysis
D000911:Antibodies, Monoclonal; D018936:Hepatitis C Antigens; D014758:Viral Core Proteins; D007372:Interferons