Recurrent Hepatitis C-Related Membranoproliferative Glomerulonephritis in a Simultaneous Liver-Kidney Transplant Recipient With Atypical Presentation and Clinical Course

Abstract

Hepatitis C virus (HCV) infection is known to be associated with membranoproliferative glomerulonephritis (MPGN) with or without coexistent cryoglobulinemia. We report a patient with end-stage liver and renal disease caused by HCV infection (biopsy-proven liver cirrhosis and MPGN, respectively). Approximately 10 months after simultaneous liver-kidney transplantation, patient developed severe acute kidney injury (AKI) with tripling of the baseline serum creatinine level. Allograft biopsy showed recurrent HCV-related cryoglobulinemic MPGN. However, urinalysis done immediately prior to biopsy did not suggest MPGN (lack of proteinuria and microscopic hematuria). Subsequent clinical course was also atypical in that the severe AKI resolved spontaneously and completely over 2 weeks without any change in maintenance post-transplant immunosuppressive medications, or use of plasmapheresis or HCV-antiviral therapy. Three months after resolution of recurrent MPGN-related AKI, institution of interferon-free anti-HCV therapy (sofosbuvir + ribavirin) resulted in clearance of HCV viremia over 18 weeks while liver and kidney transplant function remained stable/good. This patient illustrates the following: HCV-related MPGN may recur in the kidney transplant without typical urinary findings, and the resultant (even severe) AKI may resolve spontaneously without specific treatment and the excellent outcome that can be achieved with the newer anti-HCV therapies.




World J Nephrol Urol. 2014;3(4):157-161
doi: http://dx.doi.org/10.14740/wjnu185e