MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS ASSOCIATED WITH HEPATITIS-C VIRUS-INFECTION
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS ASSOCIATED WITH HEPATITIS-C VIRUS-INFECTION
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DOI：
10.1056/nejm199302183280703
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发表时间：
1993-02-18
影响因子：
158.5
通讯作者：
WILLSON, R
中科院分区：
文献类型：
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作者：
JOHNSON, RJ;GRETCH, DR;WILLSON, R
研究背景和方法。丙型肝炎病毒(丙型肝炎病毒)感染导致急性和慢性肝病，也与混合性冷球蛋白血症有关。目前尚不清楚丙型肝炎病毒是否也与肾脏疾病有关，就像乙肝病毒一样。我们描述了8例丙型肝炎病毒感染患者的临床、病理、病毒学和免疫学特征，他们因肾小球肾炎而被转诊至肾脏科医生。4例患者应用干扰素α治疗。所有8名患者都有蛋白尿，7名患者肾功能下降。所有患者的肾活检均显示膜增生性肾小球肾炎，其特征是肾小球内有免疫球蛋白、免疫球蛋白M和补体C3的沉积。活检标本的电子显微镜显示，四名患者中有三名患者具有冷球蛋白样结构。所有8名患者的血清中都检测到了丙型肝炎病毒RNA，血清转氨酶浓度升高，以及低补体血症，大多数患者的血清中存在冷冻球蛋白和循环免疫复合体。三名接受检测的患者的冷沉淀物中含有针对核衣壳核心抗原(HCVc或c22-3)的丙型肝炎病毒RNA和抗丙型肝炎病毒抗体。在所有患者中存在的IgM类风湿因子，在所有六名患者中都结合了抗丙型肝炎病毒免疫球蛋白。4名患者接受干扰素治疗2至12个月；所有患者都有证据表明，丙型肝炎病毒复制减少，肾脏和肝脏疾病得到改善。慢性丙型肝炎病毒感染与冷球蛋白血症和膜增生性肾小球肾炎有关。发病机制尚不清楚，但可能与含有丙型肝炎病毒、抗丙型肝炎病毒免疫球蛋白和IgM类风湿因子的免疫复合体在肾小球内沉积有关。
Background and Methods. Hepatitis C virus (HCV) infection causes both acute and chronic liver disease and is also associated with mixed cryoglobulinemia. Whether HCV is also associated with renal disease, as is the hepatitis B virus, is not known. We describe the clinical, pathologic, virologic, and immunologic features of eight patients with HCV infection who were referred to nephrologists for glomerulonephritis. Four patients were treated with interferon alfa.Results. All eight patients had proteinuria, and seven had decreased renal function. Renal biopsy in all patients revealed membranoproliferative glomerulonephritis, characterized by the deposition of IgG, IgM, and C3 in glomeruli. Electron microscopy of the biopsy specimens showed cryoglobulin-like structures in three of four patients. All eight patients had HCV RNA detected in their serum, elevated serum aminotransferase concentrations, and hypocomplementemia, and the majority had cryoglobulins and circulating immune complexes in their serum. Cryoprecipitates from the three patients who were tested contained HCV RNA and IgG anti-HCV antibodies to the nucleocapsid core antigen (HCVc or c22-3). IgM rheumatoid factors, present in all patients, bound anti-HCV IgG in all six patients tested. Four patients received interferon alfa for 2 to 12 months; all had evidence of decreased HCV replication and improvement of their renal and liver disease.Conclusions. Chronic HCV infection is associated with cryoglobulinemia and membranoproliferative glomerulonephritis. The pathogenesis is unknown, but may relate to deposition within glomeruli of immune complexes containing HCV, anti-HCV IgG, and IgM rheumatoid factors.