A case of HCV positive cryoglobulinemic focal necrotizing glomerulonephritis with generalized purpura

Year 2023, , 22 - 25, 30.04.2023

Aysun Yakut

https://doi.org/10.35514/mtd.2023.84

Abstract

In addition to chronic liver disease, hepatitis C (HCV) can cause many non-hepatic symptoms and signs such as hematological, dermatological, renal, autoimmune and neurological disorders. Small vessels due to the accumulation of the immune complex and complement unit. HCV infection is the most obvious secondary cause of the disease. Immune complexes settle in endothelial cells and activate all pathways of the immune system and cause damage accordingly. They also cause some systemic diseases in the central nervous system, kidneys, skin and other internal organs. Membranoproliferative glomerulonephritis has been reported in more than a quarter of HCV cases. Results obtained from patients followed for 21 years indicate that renal involvement is a sign of malignant prognosis. However, end-stage renal disease is not common in these patients. Detection of circulating crioglubulins in the laboratory, hypocomplementemia and rheumatoid factor (RF) positivity help in the diagnosis of HCV serology. These patients typically show low C4 values and normal or near-normal C3 values. In our case, active chronic HCV positivity was discussed over the patient who was consulted to the nephrology service because of nephrotic level proteinuria, hematuria, renal failure and generalized exanthema.

Keywords

HCV, focal necrotizing glomerulonephritis, mixed cryoglobulinemia, mixed cryoglobulinemia, rituximab

Jeneralize ekzantemi bulunan kriyoglobulinemik fokal nekrotizan glomerulonefritli HCV pozitif vakası

Abstract

In addition to chronic liver disease, hepatitis C (HCV) can cause many non-hepatic symptoms and signs such as hematological, dermatological, renal, autoimmune and neurological disorders. Small vessels due to the accumulation of the immune complex and complement unit. HCV infection is the most obvious secondary cause of the disease. Immune complexes settle in endothelial cells and activate all pathways of the immune system and cause damage accordingly. They also cause some systemic diseases in the central nervous system, kidneys, skin and other internal organs. Membranoproliferative glomerulonephritis has been reported in more than a quarter of HCV cases. Results obtained from patients followed for 21 years indicate that renal involvement is a sign of malignant prognosis. However, end-stage renal disease is not common in these patients. Detection of circulating crioglubulins in the laboratory, hypocomplementemia and rheumatoid factor (RF) positivity help in the diagnosis of HCV serology. These patients typically show low C4 values and normal or near-normal C3 values. In our case, active chronic HCV positivity was discussed over the patient who was consulted to the nephrology service because of nephrotic level proteinuria, hematuria, renal failure and generalized exanthema.

Keywords

HCV, focal necrotizing glomerulonephritis, mixed cryoglobulinemia, mixed cryoglobulinemia, rituximab

References

• 1. Saadoun D, Suarez F, Lefrere F, Françoise Valensi, Xavier Mariette, Achille Aouba, et al. Splenic lymphoma with villous lymphocytes, associated with type II cryoglobulinemia and HCV infection: a new entity? Blood. 2005;105:74-76.
• 2. De Vita S, De Re V, Gasparotto D, M Ballarè, B Pivetta, G Ferraccioli, et al. Oligoclonal non-neoplastic B cell expansion is the key feature of type II mixed cryoglobulinemia. Arthritis Rheum. 2000;43:94-102.
• 3. Zaja F, De Vita S, Russo D, Michelutti A, Fanin R, Ferraccioli G, et al. Rituximab for the treatment of type II mixed cryoglobulinemia. Arthritis Rheum. 2002;46:2252-2254.
• 4. Sansonno D, De Re V, Lauletta G, Tucci F, Boiocchi M, Dammacco F. Monoclonal antibody treatment of mixed cryoglobulinemia resistant to interferon alpha with an anti-CD20. Blood. 2003;101:3818-3826.
• 5. Naarendorp M, Kallemuchikkal U, Nuovo GJ, Gorevic PD. Longterm efficacy of interferon-alpha for extrahepatic disease associated with hepatitis C virus infection. J Rheumatol. 2001;28:2466-2473.
• 6. Cacoub P, Lidove O, Maisonobe T, Duhaut P, Thibault V, Ghillani P, et al. Interferon-alpha and ribavirin treatment in patients with hepatitis C virus-related systemic vasculitis. Arthritis Rheum.2002;46:3317-3326.
• 7. Rossi P, Bertani T, Baio P, Caldara R, Luliri P, Tengattini F, et al. Hepatitis C virus-related cryoglobulinemic glomerulonephritis: long-term remission after antiviral therapy. Kidney Int. 2003;63:2236-2241.
• 8. Alric L, Plaisier E, Thebault S, Péron JM, Rostaing L, Pourrat J, et al. Influence of antiviral therapy in hepatitis C virus-associated cryoglobulinemic MPGN. Am J Kidney Dis. 2004;43:617-623.