HCV cirrhotic patients treated with direct‐acting antivirals: Detection of tubular dysfunction and resolution after viral clearance

Abstract

Background/Aims: Hepatitis C virus (HCV) has been identified in tubular epithelial cells of infected patients; however, the presence of tubular dysfunction, which is a risk factor for chronic kidney disease (CKD), has never been examined in vivo. The present prospective longitudinal study aimed to estimate the prevalence of tubular dysfunction alone or with glomerular damage and its evolution after HCV clearance in cirrhotic patients. Methods: One hundred and thirty-five consecutive Child-Pugh A cirrhotic patients were evaluated before antiviral treatment and 6 months after the end of therapy. Tubular dysfunction was evaluated by urinary alpha1-microglobulin to creatinine ratio (α1-MCR), and glomerular damage was assessed by urinary albumin to creatinine ratio (ACR). Results: Almost all the patients (93.3%) showed a normal or mildly decreased e-GFR (KDIGO-G1/G2-categories). Tubular dysfunction was found in 23.7% (32/135) of patients, co-occurring with glomerular damage in 37.5% (12/32) of cases, while glomerular damage was found in 16.3% (22/135) of patients. In multiple logistic regression, glomerular damage and the concomitant presence of diabetes and hypertension were the only predictors significantly associated with tubular dysfunction. After HCV clearance, patients experienced a significant reduction of α1-MCR levels (21.0 vs 10.5 μg/mg, P = .009) and tubular dysfunction resolved in 57.1% of subjects. Conclusions: Tubular dysfunction is an unrecognized feature of HCV-related kidney disease in cirrhotic patients and its presence should be primarily investigated in subjects with glomerular damage, diabetes and hypertension, despite normal e-GFR. Tubular dysfunction resolves in the majority of cases after HCV clearance; however, | 159 BILIOTTI eT aL.

Relationship between hepatitis C and kidney stone in US females: Results from the National Health and Nutrition Examination Survey in 2007–2018

“…Researchers are reporting that tubulointerstitial damage is the early stage of renal manifestation rather than glomerular damage (20), which is positive. An Italian study of 98 cirrhotic individuals found tubular involvement to be the most prevalent kidney abnormality (33). The HCV core protein has also been shown to be more prevalent in the renal tubules of patients with HCV infection (34).…”

HCV cirrhotic patients treated with direct‐acting antivirals: Detection of tubular dysfunction and resolution after viral clearance

“…Bilotti et al's 1 recent excellent report on the prevalence of tubular and glomerular dysfunction in patients with HCV infection on direct‐acting antiviral (DAA) agents, and their evolution following HCV clearance adds to recent attempts at exploring the subclinical role of KIM‐1 (among other markers of tubular dysfunction) as early biomarkers of tubular damage. Her report showed urinary KIM‐1 thresholds (4.7 [3.4‐11.3] vs 2.1 [1.0‐3.4] ng/mg, P < .001) in patients with tubular injury compared to their normal counterparts.…”