The Spectrum of Renal Diseases in Biopsies of Patients with Hepatitis C Virus Infection
K Raparia, S Ozen, R Barrios, S Seshan, L Truong. The Methodist Hospital, Weil Cornell Medical College, Houston, TX; Baylor College of Medicine, Houston, TX
Background: Membranoproliferative glomerulonephritis (MPGN) and membranous glomerulonephritis (MGN) are well documented renal complications of Hepatitis C virus (HC) infection. Other immune-mediated GNs have been sporadically linked to HC infection. Patients with HC infection often have risk factors for other renal diseases. The spectrum of diseases in renal biopsies of patients with HC infection has not been systematically studied.
Design: Among 8045 renal biopsies accessioned in our laboratories from 2000-2008, 215 were from patients with HC infection. These biopsies were reviewed. The pathologic diagnoses were correlated with the clinical findings.
Results: Among these 215 biopsies, three diagnostic groups were found. Group I (65 biopsies, 30%) included MPGN (54) or MGN (11). Group II (11 biopsies, 5%) included several types of immune-mediated GN, which may be etiologically related to HC infection; comprising of diffuse proliferative GN (3), focal segmental proliferative GN (5), and fibrillary GN (3). Group III (139 biopsies, 65%) included a large variety of renal diseases which are pathogenetically unrelated to HC infection; they consisted of diabetic nephropathy (51), focal segmental glomerulosclerosis (28), HIV nephropathy (12), non-specific vascular scarring (7), hypertensive nephropathy (6), minimal change disease/ mesangial glomerulonephritis (6), acute tubular necrosis (6), thrombotic microangiopathy (5), lupus nephritis (5), amyloid nephropathy (2), tubulo-interstitial nephritis (2), end-stage kidney disease (2), transplant rejection (2), renal infarct (2), MGN associated with mixed connective tissue disease (1), Ig A nephropathy (1) and chronic ischemic injury (1). There was significant overlapping of the clinical features of patients within each group and among groups.
Conclusions: 1) HC infection is not infrequent in patients submitted to renal biopsies; 2) Although these biopsies often show glomerular lesions directly associated with HC infection such as MPGN or MGN, the majority of them display diseases of prognostic and therapeutic significance, unrelated to HC infection. 3) Clinical features are not helpful in predicting the renal biopsy findings.
Category: Kidney (does not include tumors)
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 191, Tuesday Afternoon