Membranous glomerulonephritis associated with hepatitis C virus infection: case report and literature review.
We describe the case of a 51-year-old man with hepatitis C virus (HCV) infection and a 3-month history of facial edema. Laboratory tests upon admission for renal biopsy showed normal renal function and normocomplementemia. Serum HCV antibody (Ab) and cryoglobulin were positive. Renal biopsy specimens showed features of membranous glomerulonephritis. The likely cause was immune complex-mediated glomerulonephritis associated with HCV infection. Reports of similar cases in the literature show the normocomplementemia and negative or slightly positive cryoglobulins observed in our case as well as seropositivity for circulating immune complexes containing HCV RNA. In our case, electron microscopic examination of the subepithelial glomerular lesions revealed massive virus-like particles within unusual multilayers of electron-dense deposits (EDDs), suggesting the existence of HCV in the glomeruli. In the addition to the unique histopathological feature the presence of La/SS-B antibody in his serum indicated an abnormal immune response associated with HCV. We advise him to undergo the therapy with new type of IFN such as pegIFN-alpha2a and/or anti-viral agent like ribavirin to achieve clinical and histopathological improvement.
Renal Division, Department of Medicine II, Kansai Medical University, Moriguchi, Osaka, Japan.
Y
Y
Uchiyama-Tanaka
Y
Y
Mori
N
N
Kishimoto
A
A
Nose
Y
Y
Kijima
T
T
Nagata
Y
Y
Umeda
H
H
Masaki
H
H
Matsubara
T
T
Iwasaka
D015433:Glomerulonephritis, Membranous / Q000473:pathology / Q000628:therapy / Q000821:virology*; D006526:Hepatitis C / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged