Background Hepatitis C virus (HCV) infection is associated with increased risk of renal disease. While HCV-related glomerular damage is well characterized, limited data are available on HCV-related tubular damage and its evolution after HCV clearance. The aim of our study was to evaluate the effect of viral eradication after direct anti-viral agents (DAAs) treatment on glomerular and tubular damage in patients with HCV-cirrhosis. Methods 94 Child- Pugh-A pts with cirrhosis treated with DAAs were consec- utively enrolled. Estimated glomerular filtration rate (e-GFR assessed by CKD-EPI equation), urinary albumin to creatinine ratio (ACR), urinary α1-microglobulin to creat- inine ratio (α1MCR) and fractional excretion of sodium (FeNa) were evaluated at baseline and six months treatment (FU-6). Glomerular damage was defined as ACR>30 mg/g and tubular damage was defined as α1MCR>14 mg/g and/or FeNa>1%. Results At base- line, glomerular and/or tubular damage occurred in 39 pts (41.5%): 20 pts had only tubular (51.3%), 9 pts had only glomerular (23.1%) and 10 pts had both tubular and glomerular (25.6%) involvement. Patients with renal damage showed significantly lower e-GFR values than patients without damage (85.1±5.8 mL/min/1.73m2 vs 95.2±15.2 mL/min/1.73m2, p<0.05). Among 33 exam- ined pts with baseline tubular involvement (3 pts died,2 relapsed,1 was lost to FU) who achieved SVR, a significant reduction of both α1MCR and FeNa was observed at FU-6 (table), while evidence of tubular involvement was still present only in 11 pts(33.3%;p<0.001). Out of 19 pts with baseline glomerular involvement, a significant FU-6 reduc- tion of ACR occurred in the 13 patients without diabetes (p=0.001), 11 of whom (84.6%) showed normal ACR values. Interestingly, no change occurred in the 6 patients with diabetes (table). Conclusions Our study is the first to demonstrate that HCV-related tubular damage may reverse after successful antiviral therapy. Instead, glomer- ular damage may improve after HCV clearance only in the absence of a competing diabetes-induced damage.
Palazzo, D., Biliotti, E., Esvan, R., Tinti, F., Volpicelli, L., Bachetoni, A., et al. (2017). Effect of interferon free antiviral therapy on glomerular and tubular kidney involvement in HCV Child-A cirrhosis. In HEPATOLOGY (pp.584A-585A). Hoboken : Wiley.
Effect of interferon free antiviral therapy on glomerular and tubular kidney involvement in HCV Child-A cirrhosis
Mitterhofer, AP
;
2017-01-01
Abstract
Background Hepatitis C virus (HCV) infection is associated with increased risk of renal disease. While HCV-related glomerular damage is well characterized, limited data are available on HCV-related tubular damage and its evolution after HCV clearance. The aim of our study was to evaluate the effect of viral eradication after direct anti-viral agents (DAAs) treatment on glomerular and tubular damage in patients with HCV-cirrhosis. Methods 94 Child- Pugh-A pts with cirrhosis treated with DAAs were consec- utively enrolled. Estimated glomerular filtration rate (e-GFR assessed by CKD-EPI equation), urinary albumin to creatinine ratio (ACR), urinary α1-microglobulin to creat- inine ratio (α1MCR) and fractional excretion of sodium (FeNa) were evaluated at baseline and six months treatment (FU-6). Glomerular damage was defined as ACR>30 mg/g and tubular damage was defined as α1MCR>14 mg/g and/or FeNa>1%. Results At base- line, glomerular and/or tubular damage occurred in 39 pts (41.5%): 20 pts had only tubular (51.3%), 9 pts had only glomerular (23.1%) and 10 pts had both tubular and glomerular (25.6%) involvement. Patients with renal damage showed significantly lower e-GFR values than patients without damage (85.1±5.8 mL/min/1.73m2 vs 95.2±15.2 mL/min/1.73m2, p<0.05). Among 33 exam- ined pts with baseline tubular involvement (3 pts died,2 relapsed,1 was lost to FU) who achieved SVR, a significant reduction of both α1MCR and FeNa was observed at FU-6 (table), while evidence of tubular involvement was still present only in 11 pts(33.3%;p<0.001). Out of 19 pts with baseline glomerular involvement, a significant FU-6 reduc- tion of ACR occurred in the 13 patients without diabetes (p=0.001), 11 of whom (84.6%) showed normal ACR values. Interestingly, no change occurred in the 6 patients with diabetes (table). Conclusions Our study is the first to demonstrate that HCV-related tubular damage may reverse after successful antiviral therapy. Instead, glomer- ular damage may improve after HCV clearance only in the absence of a competing diabetes-induced damage.File | Dimensione | Formato | |
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