Acta Medica Medianae
Vol. 53, No 1, March, 2014
UDC 61
ISSN 0365-4478(Printed version)
ISSN 1821-2794(Online)
 

Correspondence to:

Boriana Kiperova

Clinic of Nephrology

University Hospital “Lozenetz”

1, Koziak Str., 1431 Sofia, Bulgaria

E-mail: bkiperova@gmail.com

Review article          

UDC: 616.98:616.61

doi:10.5633/amm.2014.0111

  Glomerular diseases associated with HBV and HCV infection

 Boriana Kiperova

Clinic of Nephrology, University Hospital “Lozenetz”, Sofia, Bulgaria

Hepatitis B and C viruses are human pathogens of major significance. Their extrahepatic manifestations are global health problem. HBV is a well-known cause of membranous nephropathy, membranoproliferative GN and IgA nephropathy, frequently in Asian populations. Polyarteritis nodosa is a rare, but serious systemic complication of chronic HBV. Immunosuppressive therapy in HBV-related GN is not recommended.  Interferon alpha treatment produces sustained remission of porteinuria, often associated with clearance of HBeAg and/or HBsAg, however, it has many side effects. Compared to interferon, nucleos(t)ide analogues offer some advantages. These antiviral agents suppress HBV replication through their inhibitory effect on viral DNA polymerase.  They have convenient administration and high tolerability. Lamivudine is well tolerated and safe in long-term studies, but the resistance of HBV is an escalating problem. The resistance to newer polymerase inhibitors Entecavir and Tenofovir is significantly lower.  Hepatitis C virus causes cryoglobulinemia-mediated glomerulonephritis and  other immune complex forms of GN. The renal manifestations are usually associated with long-lasting HCV infection. HCV glomerular disease is more frequent in adult males, and often leads to chronic renal insufficiency. The first line treatment in patients with mild to moderate clinical and histological kidney damage is the antiviral therapy with pegylated INF alpha and ribavirin. In case of severe HCV-associated cryoglobulinemic GN - nephrotic syndrome, nephritic syndrome and/or progressive renal failure, high activity score of glomerulonephritis on light microscopy, the initial treatment might consist of sequential administration of antiviral and immunosuppressive agents (corticosteroids, cyclophosphamide and plasma exchange), or rituximab. The treatment of HCV-related glomerular disease is still under debate and based on scant experimental evidence. Large randomized and controlled clinical trials are needed to establish guidelines for the treatment of HCV-related cryoglobulinemic glomerulonephritis. Acta Medica Medianae 2014;53(1):58-64.

      Key words: hepatitis B virus, hepatitis C virus, glomerular disease, antiviral treatment