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For further information, see CMDT Part 22-14: Nephritic Spectrum Glomerular Diseases

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

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