Published: 2022-09-23

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

Jasmeen Chahal, Harleen Sood, Aman Bharti


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 associated with 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.


CG, Hepatitis C, MPGN, Directly acting antivirals

Full Text:



Johnson RJ, Willson R, Yamabe H, Couser W, Alpers CE, Wener MH et al. Renal manifestations of hepatitis C virus infection. Kidney Int. 1994;46:1255-63.

Ozkok A, Yildiz A. Hepatitis C virus associated glomerulopathies. World J Gastroenterol. 2014;20(24):7544-54.

Pascual M, Perrin L, Giostra E, Schifferli JA. Hepatitis C virus in patients with cryoglobulinemia type II. J Infect Dis. 1990;162:569-70.

Ferri C, Greco F, Longombardo G. Association between hepatitis C virus and mixed cryoglobulinemia. Clin Exp Rheumatol. 1991;9:621-4.

Ferri C, Greco F, Longombardo G, Palla P, Marzo E, Moretti A. Hepatitis C virus antibodies in mixed cryoglobulinemia. Clin Exp Rheumatol. 1991;9:95-6.

Sumida K, Ubara Y, Hoshino J, Suwabe T, Nakanishi S, Hiramatsu R et al. Hepatitis C virus-related kidney disease: Various histological patterns. Clin Nephrol. 2010;74:446-56.

Fabrizi F, Plaisier E, Saadoun D, Martin P, Messa P, Cacoub P. Hepatitis C virus infection, mixed cryoglobulinemia, and kidney disease. Am J Kidney Dis. 2013;61:623-37.

Yamabe H, Johnson RJ, Gretch DR, Osawa H, Inuma H, Sasaki T et al. Membranoproliferative glomerulonephritis associated with hepatitis C virus infection responsive to interferon-alpha. Am J Kidney Dis. 1995;25:67-9.

Jadoul M, Berenguer MC, Doss W, Fabrizi F, Izopet J, Jha V et al. Executive summary of the 2018 KDIGO Hepatitis C in CKD Guideline: welcoming advances in evaluation and management. Kidney Int. 2018;94(4):663-73.

Cacoub P, Vautier M, Desbois AC. Effectiveness and cost of hepatitis C virus cryoglobulinaemia vasculitis treatment: from interferon-based to direct-acting antivirals era. Liver Int. 2017;37:1805-13.

Sise ME, Bloom AK, Wisocky J, Lin MV, Gustafson JL, Lundquist AL et al. Treatment of hepatitis C virus-associated mixed cryoglobulinemia with direct-acting antiviral agents. Hepatology. 2016;63:408-17.

Nayak S, Kataria A, Sharma M K, Rastogi A, Gupta E, Singh A, Tiwari S C. Hepatitis C virus-associated membranoproliferative glomerulonephritis treated with directly acting antiviral therapy. Indian J Nephrol. 2018;28:462-4.