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

Abstract

Hepatitis E virus genotype-3 (HEV3) infection can cause chronic hepatitis in immunosuppressed patients and induce extra-hepatic manifestations, such as neurological symptoms, kidney injuries, and immune-mediated thrombocytopenia. Very few cases of HEV-induced kidney manifestations have been reported. Herein, we report, for the first time, a case of de novo membranoproliferative glomerulonephritis that occurred in a kidney transplant patient who developed a chronic HEV3 infection, which was successfully treated with ribavirin.

Ribavirin therapy of hepatitis E infection may cause hyporegenerative anemia in pediatric renal transplant patients

“…HEV‐associated renal manifestations such as reduction of kidney function, membranous glomerulonephritis, and membranoproliferative glomerulonephritis have been described in few adult patients . In all cases, kidney function improved after HEV clearance . In the present case, we found newly developed subendothelial deposits and a strongly positive C3 and IgM staining in the mesangium and on the basement membrane in a predescribed transplant glomerulopathy 4 months after a previous biopsy and 1 month after the first detection of HEV‐RNA in plasma.…”

“…HEV‐associated renal manifestations such as reduction of kidney function, membranous glomerulonephritis, and membranoproliferative glomerulonephritis have been described in few adult patients . In all cases, kidney function improved after HEV clearance .…”

Treatment of hepatitis C-related kidney disease

“…RBV monotherapy for HCV-related liver disease lowers aminotransferase levels but does not ameliorate histology of the liver; the viral load persists regardless of treatment. RBV monotherapy proved recently to be effective and safe for chronic hepatitis E virus infection in transplant recipients [87] and hepatitis E virusassociated cryoglobulinemic MPGN [88]. A number of cases have shown the benefit of RBV therapy on HCV-induced glomerular disease.…”

Treatment of HEV Infection in Patients with a Solid-Organ Transplant and Chronic Hepatitis

“…Although it allowed clearing of HEV, its effects on the outcome of neurological symptoms is unknown. In contrast, antiviral HEV therapy was efficient in treating patients who developed HEV-associated kidney injuries [43,44]. …”