title: Hepatitis E Virus-Induced Cryoglobulinemic Glomerulonephritis in a Nonimmunocompromised Person.
abstract: Hepatitis E virus (HEV)-related kidney disease and symptomatic cryoglobulinemia have been observed in solid-organ transplant recipients. However, HEV RNA in the cryoprecipitate has not yet been assessed. We report what to our knowledge is the first documented case of autochthonous HEV-induced cryoglobulinemic crescentic and membranoproliferative glomerulonephritis in an immunocompetent man with no notable medical history. He presented with edema, hypertension, increased serum creatinine level, and nephrotic syndrome. Type II cryoglobulinemia with monoclonal immunoglobulin G (IgG) κ light chain was detected. Anti-HEV IgG and IgM, as well as HEV RNA, were detected in serum and cryoprecipitate. Histologic analysis of a kidney biopsy specimen revealed features of crescentic and membranoproliferative glomerulonephritis. After HEV clearance, kidney and liver parameters improved and HEV RNA and cryoglobulinemia were undetectable. Hence, we conclude that HEV can cause severe kidney disease and should be considered in cases of unexplained glomerular disease.
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Guinault
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: David
authors.initials: D
authors.lastname: Ribes
authors.affiliation: Laboratory of Pathology, Institut Universitaire du Cancer de Toulouse, Toulouse, France; Université Paul Sabatier, Toulouse, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Delas
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France; Laboratory of Pathology, Institut Universitaire du Cancer de Toulouse, Toulouse, France.
authors.forename: David
authors.initials: D
authors.lastname: Milongo
authors.affiliation: Université Paul Sabatier, Toulouse, France; Laboratory of Virology, CHU Purpan, Toulouse, France; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Abravanel
authors.affiliation: Université Paul Sabatier, Toulouse, France; Laboratory of Immunology, CH Rangueil, Toulouse, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Puissant-Lubrano
authors.affiliation: Université Paul Sabatier, Toulouse, France; Laboratory of Virology, CHU Purpan, Toulouse, France; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France; Université Paul Sabatier, Toulouse, France; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France. Electronic address: kamar.n@chu-toulouse.fr.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D003449:Cryoglobulinemia / Q000150:complications / Q000821:virology*; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications / Q000821:virology*; D016751:Hepatitis E / Q000150:complications*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged
keywords: Hepatitis E virus (HEV); cryoglobulinemia; cryoprecipitate; immunocompetent; kidney biopsy; membrano-proliferative glomerulonephritis (MPGN); membrano-proliferative glomerulopathy; nephrotic syndrome; renal disease; viral RNA