Hepatitis C associated membranoproliferative glomerulonephritis treated with directly acting antivirals for hepatitis C

Hepatitis C virus (HCV) infection affects kidneys with different histopathological patterns on kidney biopsy, which commonly include membranoproliferative glomerulonephritis (MPGN) pattern with mixed cryoglobulinemia (CG), thrombotic microangiopathy, membranous nephropathy and small to medium vessel vasculitis. Type 1 MPGN associated with type II mixed CG is the most common glomerulopathy associated with hepatitis C infection. Treatment of these glomerulopathies and cryoglobulinemic renal disease associatedwith HCV infection includes antiviral therapy for HCV, B-cell depletion therapy for prevention of immune complexes and cryoglobulins or nonspecific immunosuppressive therapy. We describe a patient who presented to us with HCV associated MPGN type 1 with cryogloblinemia and detectable HCV RNA, who recovered completely with directly acting antiviral agents (DAA) alone without immunosuppression.

Rituximab Therapy for Post-Liver Transplant Membranoprolifertive Glomerulonephritis Associated with Hepatitis C Viral Infection

Post-transplant membranoprolifertive glomerulonephritis(MPGN), due to hepatitis C virus, is a serious immunecomplex disease with potential for both kidney and liver loss.Treatment with corticosteroids and immunosuppressive canactivate viral infection and the use of interferon alpha caninduce acute rejection of the transplanted liver. In this casereport; a lady, with hepatitis C genotype 4, had developedsevere nephrotic syndrome with progressive renal failure dueto MBGN following liver transplant. Initially, she had receivedHarvoni (Ledipasvir/sofosbuvir) 90/400 mg daily for 12 weeks.Despite, clearance of hepatitis C viremia, she did not improve.Hence, Rituximab was started. Fortunately, her renal failureand nephrotic state improved without activation of hepatitis Cinfection or induction of rejection.

First diagnosis of IgA nephropathy by renal biopsy in Mongolia / Монголын Анагаах Ухаан

BackgroundIgA nephropathy and MPGN are common glomerulonephritis in the world that progresses slowly andrenal function can even remain unchanged for decades. Clinically, it presents by isolated hematuria,proteinuria. Histologically, IgA nephropathy presents with acute glomerular damage, mesangial cellproliferation, endocapillary leucocyte infiltration, and crescent formations, these lesions can undergoresolution with sclerotic healing. Since 2013, renal biopsy has been done at the First Central Hospitalof Mongolia a few times. However, the confirmative diagnosis of IgA nephropathy and MPGN remainunknown in Mongolia by renal biopsy. Therefore, we intended to test renal biopsy techniques andconfirm its diagnosis by renal biopsy at the Second Central Hospital of Mongolia.MethodsUltrasound guided renal biopsy had been done for four patients by nephrologist at the Departmentof Nephrology of the Second Central Hospital of Mongolia. All four specimens were evaluated assatisfactory which show more than 8 glomerulus under the light microscopy. Each renal cortical tissuewas divided into two tips: one piece for routine H&E stain and special stains, including Masson’strichrome, and PAS stain; another piece for immunofluorescence by frozen section, which werestained with IgG, IgM, IgA and complement component 3 (C3). Each case was screened by threepathologists.Results:The case which shows mesengial widening, mesengial hypercellularity under the light microscopyor mesangial granular deposition of IgA and C3 by immunofluorescence was diagnosed as IgAnephropathy. We obtained crescent formation with glomerular adhesion in most cases. In addition, weobserved secondary MPGN in one case, which is caused by hepatitis C virus infection.Conclusion: Probably, it is a new step for developing pathologic diagnosis for nephrology in Mongolia.We needs further study for improving renal biopsy technique and confirming the diagnosis of IgAnephropathy and MPGN using electron microscopy and pathological report by oxford classification forIgA nephropathy.

Nephrotic Syndrome: A Rare Presentation of AIDS.

The clinical presentation of HIV-associated nephropathy (HIVAN) include proteinuria, typically in nephrotic range (often massive) and renal insufficiency. HIVAN can be an early manifestation of HIV infection. The term HIVAN is reserved for focal segmental glomerulosclerosis (FSGS) but other glomerular lesions may be there. We are reporting a case of nephrotic syndrome (MPGN) in an otherwise asymptomatic HIV-infected patient.

A Case of Type II Membranoproliferative Glomerulonephritis Detected by School Urinary Screening Tests

Type II membranoproliferative glomerulonephritis (MPGN) is characterized by thickening of the glomerular basement membrane owing to electron-dense deposits on electron microscopy. We experienced a case of type II MPGN in a child presenting with proteinuria, hematuria on school urinary screening tests. He had been treated with losartan and enalapril. This is the first case report of type II MPGN detected by school urinary screening tests in Korea. Thus we report a case of 10-years-old male with type II MPGN with a review of brief literature.

Clinical characteristics of idiopathic membranoproliferative glomerulonephritis / 대한내과학회지

BACKGROUND: Idiopathic membranoproliferative glomerulonephritis (MPGN) is a chronic primary glomerular disease that occurs in both children and adults, with generally progressive course. We have examined the clinical and long-term outcome of patients with idiopathic MPGN at Keimyung University Dongsan Medical Center. METHODS: Of the total 1,971 patients with biopsy-proven glomerulonephritis over the 21-year period from June 1982 and June 2003, there were 51 cases of idiopathic MPGN of whom 49 had type I and two type II. RESULTS: Of the total 51 idiopathic MPGN, male to female ratio was 1.7:1, a mean age at diagnosis was 32 +/- 17 years (range; 6-70) and 50% of the patients were under the age of 30. The clinical presentations at the time of diagnosis were nephrotic syndrome (70%), asymptomatic urinary abnormality (18%), acute nephritic syndrome (6%), and recurrent gross hematuria (6%). Of the 40 patients who followed more than 6 months, with a mean follow-up of 71months, 10 patients progressed to end-stage renal disease. The renal survival at 5 and 10 years after diagnosis were 86 and 52%, respectively. Eight (20%) patients obtained a complete remission and none of them progressed to end-stage renal failure. The quantity of proteinuria at the time of biopsy was much more prominent in deteriorating group, though not significant (p=0.05) and young age and female seemed associated with the complete remission (p<0.05). CONCLUSION: Idiopathic MPGN remains a disease with a poor prognosis. Age, gender and quantity of proteinuria at the time of diagnosis were associated with the prognosis. Further prospective study with larger number of patients would be necessary to assess the prognostic factors and effective therapy for idiopathic MPGN.

Effect of Cyclophosphamide as the Treatment of Recurrent Membranoproliferative Glomerulonephritis after Renal Transplantation / 대한이식학회지

The treatment of recurrent type 1 membranproliferative glomerulonephritis (MPGN) after renal transplantation is undetermined yet. We report a case with a recurrent type 1 MPGN with ascites after renal transplantation that had a favorable outcome. A woman aged 50 was diagnosed recurrent type 1 MPGN in 2002. Afterwards she took cyclosporine, prednisolone and mycophenolate mofetil. Since August 2003, Her urine output was reduced and she suffered from abdominal distention. Serum creatinine was elevated to 2.5 mg/dL and physical examination and abdominal CT scan showed large amount of ascites. So, we substituted cyclophosphamide for mycophenolate mofetil. She was 55 kg before the substitution of cyclophosphamide but 12 months later, she weighed 44 kg and her creatinine decreased to 1.5 mg/dL. Therefore, it seems a good idea to use cyclophosphamide for the treatment of recurrent glomerulonephritis with ascites after renal transplantation.

A Case of Rapidly Progressive Glomerulonephritis (RPGN) Occurring Four Years after Kidney Transplantation / 대한신장학회잡지

Immunosuppressive medications after renal allograft transplantation have impacted the course of acute and chronic rejection: however, they have no defined effects on the prevention of recurrent and Glomerulonephritis (GN) in an allograft kidney. Authors experienced a case of rapidly progressive glomerulonephritis (RPGN). The 35-year-old female patient developed a rapid deterioration of renal function 4 years after renal transplantation. The allograft biopsy showed crescentic glomerulonephritis evolving from membranoproliferative glomerulonephritis (MPGN) type I. She was given pulse steroid and oral cyclophosphamide therapy immediately after the renal biopsy. Graft function stabilized and proteinuria decreased even though graft function did not recover to pre-treatment level and low grade proteinuria persisted.

A Case Complicated with Collagen Disease Related with SLE during Hemodialysis / 日本農村医学会雑誌

A 60-year-old man who developed a nephrotic syndrome underwent a renal biopsy, and the case was diagnosed as membranoproliferative glomerulonephritis (MPGN). Despite chemotherapy using steroid, immunosuppresive and anticoagulant drugs, the patient exhibited persistently high urinary protein levels (above 8 g/day), and the renal function deteriorated gradually.<BR>One and half years later, hemodialysis was started, but soon he had a high fever (above 38-40°C). Laboratory data revealed high levels of both antinuclear antibody titer and immune complex (IC) titer, and a low level of CH50.<BR>Considering an active collagen disease like SLE, steroid pulse therapy and plasma exchange were instituted. The therapy was very effective this time.<BR>It is well known that many patients with SLE and a long term history of hemodialysis develop a condition of so called “burn out” in which the activity of SLE declined to allow the withdrawal of steroid therapy. Also well known is the developement of hypocomplementemia in many patients with MPGN.<BR>In our case, it was difficult to clarify what caused the high fever and other clinical symptoms. We must carefully observe the clinical symptoms of SLE.