Hepatitis C Virus–Associated Kidney Disease

Key Features

• Kidney disease can occur in the setting of HCV infection

• Three patterns of kidney injury associated with HCV

  • Secondary MPGN (most common)

  • Cryoglobulinemic glomerulonephritis

  • Membranous nephropathy

Clinical Findings

• Depend on underlying pattern of injury

Diagnosis

• Elevated serum transaminases

• Elevated rheumatoid factor

• Hypocomplementemia is very common, with C4 typically more reduced than C3

• Complement levels and rheumatoid factor tend to be normal if there is a membranous pattern of injury

Treatment

• Viral suppression or eradication is the cornerstone of treatment of HCV–associated kidney disease

• Use of most direct-acting antiviral agents appears to be safe in those with reduced GFR, with the exception of sofosbuvir

• Rituximab and possibly corticosteroids and plasmapheresis should be given to patients with severe vasculitis prior to the initiation of antiviral therapy