Massive Hemolysis Causing Renal Failure in Acute Hepatitis E Infection

Shrestha, Anuj; Malik, Shahid; Mallick, Bipadabhanjan; Sharma, Vishal

doi:10.14218/jcth.2016.00042

Cited by 10 publications

(8 citation statements)

References 8 publications

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“…Cases of hemolysis and subsequent renal failure are reported with HEV infection. Karki et al [ 30 ] reported a case of massive hemolysis in a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency, heme pigment causing direct proximal tubular toxicity. Development of hemoglobin cast further leads to intratubular obstruction and subsequent development of acute kidney injury.…”

Section: Renal Manifestations Of Hev Infectionmentioning

confidence: 99%

Renal manifestations of hepatitis E among immunocompetent and solid organ transplant recipients

Kovvuru¹,

Carbajal²,

Pakanati³

et al. 2022

WJH

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Hepatitis E virus (HEV) infections are generally self-limited. Rare cases of hepatitis E induced fulminant liver failure requiring liver transplantation are reported in the literature. Even though HEV infection is generally encountered among developing countries, a recent uptrend is reported in developed countries. Consumption of unprocessed meat and zoonosis are considered to be the likely transmission modalities in developed countries. Renal involvement of HEV generally holds a benign and self-limited course. Although rare cases of cryoglobulinemia are reported in immunocompetent patients, glomerular manifestations of HEV infection are frequently encountered in immunocompromised and solid organ transplant recipients. The spectrum of renal manifestations of HEV infection include pre-renal failure, glomerular disorders, tubular and interstitial injury. Kidney biopsy is the gold standard diagnostic test that confirms the pattern of injury. Management predominantly includes conservative approach. Reduction of immunosuppressive medications and ribavirin (for 3-6 mo) is considered among patients with solid organ transplants. Here we review the clinical course, pathogenesis, renal manifestations, and management of HEV among immunocompetent and solid organ transplant recipients.

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Section: Renal Manifestations Of Hev Infectionmentioning

confidence: 99%

Renal manifestations of hepatitis E among immunocompetent and solid organ transplant recipients

Kovvuru¹,

Carbajal²,

Pakanati³

et al. 2022

WJH

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“…Regarding HEV-1 infection, the link between viral infection and acute kidney injury (AKI) and/or KFTs is not clear. Karki et al reported a case of acute HEV infection associated with hemolysis and kidney injury, which required renal dialysis [ 28 ]. Nayak et al reported a case of acute HEV infection that was complicated by cholemic nephrosis (bile cast nephropathy), which could lead to AKI [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…HEV-1 replicates in primary proximal epithelial cells, and HEV RNA and HEV protein increase over time; the infection activates the inflammatory cytokines IL-8 and IL-6, but not chemokine transcripts or kidney injury markers [ 27 ]. In India, where HEV-1 is a common genotype, several HEV-infected cases were found to be complicated by renal failure or cholemic nephrosis [ 28 , 29 ]. In Egypt, HEV-1 is the most commonly reported strain associated with acute hepatitis and fulminant hepatic failure [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

First Report on Abnormal Renal Function in Acute Hepatitis E Genotype 1 Infection

et al. 2023

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Impaired renal functions have been reported with Hepatitis E virus (HEV) infections, especially with genotypes 3 and 4. These complications were reported during the acute and chronic phases of infection. HEV genotype 1 causes acute infection, and the effect of HEV-1 infections on renal functions is not known. We examined the kidney function parameters in the serum of HEV-1 patients (AHE, n = 31) during the acute phase of infection. All of the included patients developed an acute self-limiting course of infection, without progression to fulminant hepatic failure. We compared the demographic, laboratory, and clinical data between AHE patients with normal kidney function parameters and those with abnormal renal parameters. Out of 31 AHE patients, 5 (16%) had abnormal kidney function tests (KFTs) during the acute phase of infection. Three patients had abnormal serum urea and creatinine, and two patients had either abnormal urea or creatinine. Four out of five patients had an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. AHE patients with abnormal KFTs were older and had a lower level of albumin, but a slightly elevated alanine transaminase (ALT) compared to AHE patients with normal KFTs. There were no significant differences between the two groups in terms of age, sex, liver transaminase levels, and the viral load. Similarly, the clinical presentations were comparable in both groups. Interestingly, these KFTs in patients with abnormal renal parameters returned to normal levels at the recovery. The serum creatinine level was not correlated with patients’ age or liver transaminase levels, but it was significantly negatively correlated with albumin level. In conclusion, this study is the first report that evaluated KFTs in patients during the acute phase of HEV-1 infections. Impaired KFTs in some AHE patients resolved at convalescence. KFTs and renal complications should be monitored during HEV-1 infections.

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“…In addition to acute and chronic hepatitis, HEV infection is associated with several extrahepatic manifestations, including anemia [ 117 ]. Most cases of anemia during HEV infection are due to hemolysis secondary to glucose-6-phospate dehydrogenase deficit [ 118 , 119 , 120 , 121 , 122 , 123 , 124 ]. However, a few cases of AIHA have been described both in adults and children [ 125 , 126 , 127 ].…”

Section: Hepatic and Gastrointestinal Disorders Predisposing To Aumentioning

confidence: 99%

Diagnosis and Management of Autoimmune Hemolytic Anemia in Patients with Liver and Bowel Disorders

Bianco

Coluccio

Prati

et al. 2021

JCM

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Anemia is a common feature of liver and bowel diseases. Although the main causes of anemia in these conditions are represented by gastrointestinal bleeding and iron deficiency, autoimmune hemolytic anemia should be considered in the differential diagnosis. Due to the epidemiological association, autoimmune hemolytic anemia should particularly be suspected in patients affected by inflammatory and autoimmune diseases, such as autoimmune or acute viral hepatitis, primary biliary cholangitis, and inflammatory bowel disease. In the presence of biochemical indices of hemolysis, the direct antiglobulin test can detect the presence of warm or cold reacting antibodies, allowing for a prompt treatment. Drug-induced, immune-mediated hemolytic anemia should be ruled out. On the other hand, the choice of treatment should consider possible adverse events related to the underlying conditions. Given the adverse impact of anemia on clinical outcomes, maintaining a high clinical suspicion to reach a prompt diagnosis is the key to establishing an adequate treatment.

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Massive Hemolysis Causing Renal Failure in Acute Hepatitis E Infection

Cited by 10 publications

References 8 publications

Renal manifestations of hepatitis E among immunocompetent and solid organ transplant recipients

Renal manifestations of hepatitis E among immunocompetent and solid organ transplant recipients

First Report on Abnormal Renal Function in Acute Hepatitis E Genotype 1 Infection

Diagnosis and Management of Autoimmune Hemolytic Anemia in Patients with Liver and Bowel Disorders

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