Does end-stage kidney failure influence hepatitis C progression in hemodialysis patients?
OBJECTIVE
The influence of end-stage kidney failure on the progression of liver disease in patients infected with hepatitis C virus and treated with hemodialysis is still controversial.


METHODS
Liver histology of 154 hepatitis C virus infected non-uremic patients was compared with liver histology of 13 hepatitis C virus infected uremic patients treated with hemodialysis.


RESULTS
In either group of altogether 167 patients, no normal liver histology was found. Each patient had at least a low-grade lobular and/or portal inflammation. However, statistically significant differences were observed between hepatitis C virus infected uremic and non-uremic patients in the extent of intralobular changes, portal inflammation, and degree of fibrosis.


CONCLUSIONS
Non-uremic hepatitis C virus infected patients appear to have more active and progressive liver disease than hepatitis C virus infected patients on hemodialysis. Regular follow-up of uremic patients, associated with earlier detection of hepatitis C virus infection, so as suggested uremia-associated impaired immunoreactivity and increased levels of hepatocyte growth factor described recently, might be implicated in a more favorable course of hepatitis C virus infection in uremic patients. In addition, due to the absence of normal liver histology in either group of hepatitis C virus infected patients, we propose liver biopsy to be mandatory in all these patients, provided that no contraindications exist clinically.
Luzar
Bostjan
B
Institute of Pathology, Medical Faculty University of Ljubljana, Slovenia. luzar@mf.uni-lj.si
Ferlan-Marolt
Vera
V
Brinovec
Vladimir
V
Lesnicar
Gorazd
G
Klopcic
Ulrika
U
Poljak
Mario
M
D018450:Disease Progression; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D008099:Liver / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D006435:Renal Dialysis; D012307:Risk Factors; D012720:Severity of Illness Index; D019562:Viral Load