Hepatitis E virus infection as a new probable cause of de novo membranous nephropathy after kidney transplantation

Abstract

Hepatitis E virus (HEV) has been identified as a cause of chronic viral hepatitis in immunocompromised patients. Some glomerular diseases were found to be associated with this infection. We report the first case, to our knowledge, of a kidney transplant recipient who developed an HEV infection and de novo membranous nephropathy (MN) concomitantly. The patient displayed a hepatic cytolysis first and a nephrotic syndrome occurred 3 months later. HEV infection was diagnosed upon positive polymerase chain reaction on plasma and stool samples, and renal allograft biopsy revealed de novo MN. Typical causes of MN were definitively excluded. A 3-month course of ribavirin monotherapy allowed the patient to mount a sustained viral response that was rapidly followed by complete remission of the nephrotic syndrome. The chronology of the onset and remission of both diseases is highly suggestive of a causal relationship between hepatitis E and MN.

Successful treatment of hepatitis E virus‐associated cryoglobulinemic membranoproliferative glomerulonephritis with ribavirin

“…In a recent retrospective study, decreased GFRs occurred during the acute phase of HEV3 infection in solid organ transplant patients . In addition, some patients developed renal injury during acute and chronic phases of HEV infection, such as MPGN, membranous GN, or relapsing IgA nephropathy .…”

“…It can cause resolving hepatitis, fulminant hepatitis in patients who have an underlying liver disease, or chronic hepatitis and cirrhosis in immunosuppressed patients, such as patients who have received a solid organ transplant, patients who are human immunodeficiency virus‐positive, and hematology patients receiving chemotherapy . In addition, HEV infection can induce extra‐hepatic manifestations, such as neurological symptoms , kidney injuries , or severe thrombocytopenia . However, until now, very few cases of HEV‐induced kidney manifestations have been reported .…”

“…In addition, HEV infection can induce extra‐hepatic manifestations, such as neurological symptoms , kidney injuries , or severe thrombocytopenia . However, until now, very few cases of HEV‐induced kidney manifestations have been reported .…”

Chronic hepatitis E: A brief review

“…Cryoglobulinemia was also noted in 70% of these patients, with complete resolution following therapy with ribavirin. A case of membranous glomerulonephritis associated with chronic HEV infection in a kidney transplant recipient has also been reported [34] . Nephrotic syndrome improved after the introduction of ribavirin, and completely resolved after the clearance of the virus.…”

Hepatobiliary Quiz Answers—17 (2016)

“…Patients usually present with vague symptoms, fatigue being the commonest. [48][49][50][51] Of the extrahepatic manifestations, neurological features are the most common, and include pyramidal signs, ataxia, proximal myopathy, encephalitis, cognitive dysfunction, and peripheral neuropathy. Renal manifestations include membranoproliferative glomerulopathy, membranous glomerulonephritis, IgA nephropathy and cryoglobulinemia.…”