Clinical and pathological considerations on renal diseases in patients with chronic viral hepatitis

Vol. 57 No. 2 Suppl., 2016
This supplement was not sponsored by Outside Organizations.

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vlad-Florin Iovanescu, Adriana Florentina Constantinescu, Costin Teodor Streba, Sorin-Ioan Zaharie, Cristin Constantin Vere, Eugen Mandache, Mircea Niculae Penescu, Eugen Mota

Chronic viral hepatitis B and C may associate different extrahepatic manifestations and renal disease is the most frequent. Kidney damage is represented in most cases by glomerulopathies, which include membranous nephropathy, membranoproliferative glomerulonephritis (MPGN), IgA nephropathy, focal and segmental glomerulosclerosis and diabetic nephropathy. We conducted a retrospective study on 639 patients diagnosed with chronic viral hepatitis B and C and different renal diseases. Complete evaluation of liver and renal status was performed and, in selected cases, renal biopsy. The evaluation of our cases allowed us to uncover that 82 (12.8%) patients presented a renal disease that could be linked to the viral infection. In order to identify the histopathological type of the renal lesions, kidney biopsy was performed in 39 of our patients. In hepatitis B virus (HBV) infection, the most frequent glomerulopathy was represented by membranous nephropathy, while in chronic hepatitis C infection, MPGN was responsible for the majority of glomerulonephritis. Most patients with MPGN and hepatitis C virus (HCV) also presented mixed cryoglobulinemia. Immunoglobulin A (IgA) nephropathy was present in both liver diseases while diabetic nephropathy was only found in HCV infection, in the context in which chronic hepatitis C is a risk factor for the development of type II diabetes mellitus.

Corresponding author: Vlad-Florin Iovanescu, PhD Student; e-mail: iovanescu_vlad@yahoo.com

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ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Adina Maria Kamal, Paul Mitrut, Kamal Constantin Kamal, Oana-Sorina Tica, Mihaela Niculescu, Dragos Ovidiu Alexandru, Andrei-Adrian Tica

Globally, over 4% of the world population is affected by hepatitis C virus (HCV) infection. The current standard of care for hepatitis C infection is combination therapy with pegylated interferon and ribavirin for 48 weeks, which yield a sustained virological response in only a little over half of the patients with genotype 1 HCV. We investigated the clinical importance of pharmacogenetics in treatment efficacy and prediction of hematotoxicity. A total of 148 patients infected with HCV were enrolled. All patients were treated for a period of 48 weeks or less with pegylated interferon and ribavirin. Four genotypes were investigated: inosine triphosphatase (ITPA) rs1127354, C20orf194 rs6051702, interferon lambda (IFNL)3 rs8099917, IFNL3/4 rs12979860 in the population from southwestern Romania. Genetic variants for rs129798660 and rs6051702 proved once more to represent an indisputable clinical tool for predicting sustained virological response (SVR) (69.23%, chi-square p=0.007846, p<0.05 and 63.29%, chi-square p=0.007846, p<0.05, respectively). ITPA genetic variants protect against ribavirin-induced hemolytic anemia and C20orf194 also proved to be protective against thrombocytopenia. These clinical findings strengthen the belief that pharmacogenetics should play a constant role in treatment decisions for patients infected with hepatitis C virus.

Corresponding author: Kamal Constantin Kamal, MD; e-mail: kamalconstantin@gmail.com

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