Background
Chronic hepatitis C is associated with multiple extrahepatic manifestations that may affect the infected patients. Egypt is the country with the highest incidence of hepatitis C virus (HCV) infection in the world. Hepatitis C-induced kidney disease is a devastating complication in patients with HCV infection. The development of multiple direct-acting antivirals (DAAs) has revolutionized the HCV infection treatment.
Aim
The aim was to determine the changes in immunological and biochemical parameters in patients with HCV nephropathy who receive DAA.
Patients and methods
The study included 30 patients diagnosed with HCV nephropathy according to the inclusion criteria and were tested for the immunological (C3, C4, rheumatoid factor) and biochemical parameters (urea, creatinine, urine analysis, 24 h proteins), before receiving their direct HCV antiviral agents for 12 weeks. Then participants were followed up regarding their immunological and biochemical parameters directly after termination of treatment.
Results
A total of 18 (60%) patients received sofosbuvir and daclatasvir with ribavirin, whereas 12 (40%) patients were on ombitasvir, ritnoprevir, and paritaprevir with ribavirin. Levels of transaminases were significantly improved after direct HCV antiviral agents in the current study. Significant improvement in the mean levels of blood urea and creatinine after direct HCV antiviral agents post-therapy when compared with their levels before treatment (49.16 ± 15.52 and 285.11 ± 39.07 mg/dl at pretreatment versus 25.44 ± 9.37 and185.03 ± 31.07 mg/dl after treatment respectively, with < 0.05) with significant reduction in 24-h urinary protein following the antiviral therapy. Our study showed significant improvement in C3 and C4 levels after therapy with DAA. After 12 weeks of the therapy, all patients had negative HCV RNA by PCR at follow-up.
Conclusion
HCV infection is a major medical burden in patients with chronic kidney disease. However, HCV infection itself can cause chronic kidney disease. Effective antiviral agents play an important role in improvement of HCV-related nephropathy and other extrahepatic manifestations.