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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 2  |  Page : 163-166
Liver Enzymes and Protein Electrophoretic Patterns in Hemodialysis Patients with Antibodies Against the Hepatitis C Virus


1 Department of Biochemistry, Al Noor Specialist Hospital, Saudi Arabia
2 Department of Nephrology and Hypertension Center, Al Noor Specialist Hospital, Saudi Arabia
3 Health Institute, Makkah Al Mukaramah, Saudi Arabia

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   Abstract 

One hundred and forty nine patients with end-stage renal disease on regular hemodialysis were screened for antibodies against hepatitis C virus (HCV) and hepatitis B surface antigen (HBsAg). The overall prevalence of anti-HCV was 84.6%. All patients were examined for liver functions and serum protein electrophoretic patterns. A total of 23 patients (15.4%) were negative for both anti-HCV and HBsAg (Group I), 126 (84.6%) were positive only for anti-HCV (Group II), and 12 (8.1%) patients were positive for both anti-HCV and HBsAg (Group III). No significant correlation was noted between the elevation of liver enzymes and the groups studied. A significant increase in total proteins and gamma globulin levels were observed in Groups II and III in comparison with Group I (P < 0.05). Serum albumin levels were significantly decreased and alpha-1 and beta globulin levels were significantly increased in group III patients as compared to Groups I and II (P < 0.05). The finding of a significant increase in gamma globulin levels in Groups II and III as compared to Group I requires immunoglobulin typing, an observation being currently investigated.

Keywords: Hepatitis C virus, Hemodialysis, Protein electrophoresis.

How to cite this article:
Omar MN, Tashkandy MA, El Tonsy AH. Liver Enzymes and Protein Electrophoretic Patterns in Hemodialysis Patients with Antibodies Against the Hepatitis C Virus. Saudi J Kidney Dis Transpl 1995;6:163-6

How to cite this URL:
Omar MN, Tashkandy MA, El Tonsy AH. Liver Enzymes and Protein Electrophoretic Patterns in Hemodialysis Patients with Antibodies Against the Hepatitis C Virus. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jun 3];6:163-6. Available from: http://www.sjkdt.org/text.asp?1995/6/2/163/40860

   Introduction Top


Liver involvement with a variety of viral diseases is a frequent finding in patient's end­stage renal disease on regular hemodialysis(HD) [1] . Such patients are at increased risk for infection with hepatitis B virus (HBV). In a survey performed in 1972 at 15 with dialysis centers in the United States, the prevalence of HBV infection reached 55% among patients on HD and 33% among the dialysis staff [2] . Serological tests are now available for the detection of the major agent causing non-A non-B hepatitis, namely hepatitig C viruss (HCV). In a recent multi-center study among chronic HD patients and .dialysis staff in the Czech Republic, the prevalence of anti-HCV was shown to be 47.7% [3] . The present study was conducted to evaluate the prevalence of anti-HCV and HBsAg in chronic HD patients in correlation with liver enzymes and the pattern of serum protein electrophoresis.


   Materials and Methods Top


Patients

A total of one hundred and forty nine patients (85 males and 64 females; mean age 48 ± 6 years) on HD at Al Noor Specialist Hospital, Makkah were included in the present work. All were on regular dialysis three times per week for at least six months before conducting the study. They were examined for the presence or absence of hepatomegaly, splenomegaly, ascitis and clinical signs of hepatocellular failure.

Methods

Ten mls of whole blood were drawn from each study subject before the commencement of dialysis. Sera were separated and aliquots for different assays were kept frozen at - 20° C until being analyzed.

All the samples obtained were subjected to immunological and serological assays including: a) Detection of antibodies to HCV and HIV-I and HIV-II performed by second and third generation ELISA kits respectively supplied by Abbott Diagnostics Division (Germany) and b) HBsAg, detected by using Monolisa Kits from Sanofi Diagnostics Pasteur (France).

Serum levels of alanine transaminase (ALT), aspartate transaminase (AST), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), total and direct bilirubin as well as total proteins and albumin levels were measured on all patients using Hitachi 704 fully automated analyzer (Hitachi Ltd., Tokyo, Japan) with reagents supplied by Boehringer Manheim (BM) Diagnostics (Germany). Setting up of the instrument was checked by measuring calibrators for automated system. Accuracy and precision was evaluated by measuring quality control precinorm U and precipath U from BM.

Serum protein electrophoresis was performed on Tittan cellulose acetate plates from Helena laboratories at pH 8.6. Quanti­tation of the different fractions of proteins was estimated by scanning at 525 nm.


   Results Top


Anti-HCV antibodies were detected in 126 (84.6%) of the 149 HD patients studied. Twelve (8%) of the ant-HCV positive patients were found to be poitive for HBsAg also. None of them were positive for HIV-I/ HIV-II. A total of 23 (15.4%) HD patients were negative to all markers mentioned above. Accordingly, the patients were divided into three Groups: Group I - Seronegative group, Group II - anti-HCV reactive group and Group III - combined anti-HCV and HBsAg reactive group.

[Table - 1] shows the percentage prevalence of raised serum levels of ALT, AST, GGT and ALP, above the upper limits of normal, in the different groups. No significant correlation was established between the prevalence of the elevated enzymes and the groups studied.

There was a significant increase in the serum total protein and gamma globulin levels (P < 0.05) in Groups II and III in comparison with Group I. Also, a significant decrease in serum albumin levels (P < 0.05) was observed in Group III, when compared with either I or II. On the other hand, alpha 1 and beta globulin levels showed a significant increase (P < 0.05) in Group III as compared to Group I and II. The albumin/ globulin ratio showed a significant decrease (P < 0.05) in Group III as compared to either Group I or II [Table - 2].


   Discussion Top


The prevalence of antibodies against HCV in HD units has been widely investigated m the last few years. Varying prevalence rates have been reported; 50% in Riyadh, Saudi Arabia [4] , 77.3% in Assiut, Egypt [5] , 15% in Stockholm, Sweden [6] , 41.5% in Poland [7] , 24% in Italy [8] , 29% in France [9] , 44% in Argentina [1] , 21.4% in Greece [10] , 30.7% in Japan [11] and 79.5% in Turkey [12] .

Several postulations may be considered for this high prevalence. First, renal failure patients with their lower immune response are at high risk for viral and other infections [13] . Second, it could be related to the blood transfusions given for the treatment of anemia associated with the disease [14],[15] . However, blood transfusions may not be the only route of transmission, since a prevalence of anti­HCV antibodies of 38.6% has been reported among subjects who have never been transfused [3] . In our study patients, the role of blood transfusions may be indeed low because screening of all blood donors for HBsAg and anti-HCV antibodies is mandatory in our hospital before they are accepted for donation. A third possibility, in the light of experience on hepatitis B virus [16] , is the cross-infection that may occur within the dialysis unit. Close correlation between hepatitis C viremia and anti-HCV status has been reported [11],[17],[18] a finding which entails that anti-HCV reactive dialysis patients must be considered potentially infective and should be dialyzed with separate machines and/or in separate shifts to reduce patient to patient transmission of HCV. Finally, searching for other risk factors is required.

Our study shows that elevated serum ALT and AST levels were observed in only 28.4% and 34.4% of anti-HCV positive patients respectively, a figure which was not signify­cantly different from that noted in anti-HCV negative patients. A similar poor correlation has been reported by others as well [1],[6], [7],[18],[19] .

In our study patients, serum protein electrophoresis showed a significant decrease in,albumin and increase in alpha-1, beta and gamma globulin levels in the combined anti­HCV and HBsAg positive group as compared to seronegative and anti-HCV positive groups, a finding that may reflect an increased burden on the liver.

The increase in alpha-1 globulins may be due to the increase in the alpha-1 acid glycoprotein associated with chronic inflammatory and degenerative conditions [20] and the elevated beta globulin levels may be due to an increase in serum hemopexin, transfer-rin, beta lipoprotein and/or complement-3 levels [21] , and needs further investigation. The significant increase in gamma globulins in the anti-HCV positive as well as the combined anti-HCV and HBsAg positive roups may be due to the increase in one or more of the immunoglobulins, necessitating immunoglobulin typing, an observation being currently investigated.

 
   References Top

1.Camps DH, Azcona S, Bertola S, et al. The prevalence of anti-hepatitis C virus antibodies in chronic aemodialysis patients. Medicina B Aires 1992;52(6):511-5.  Back to cited text no. 1    
2.Szmuness W, Prince AM, Grady GR, et al. Hepatitis B infection. A point prevalence study in 15 US hemodialysis centers. JAMA 1974;227:901-6.  Back to cited text no. 2    
3.Pazdiora P, Herynkova R, Opatrny K, et al. Hepatitis C virus antibodies in persons on dialysis. Cas Lek Cesk 1993;132(8):243-5.  Back to cited text no. 3    
4.Ellis ME, Alfurayh O, Halim MA, et al. Chronic non-A, non-B hepatitis complicated by end-stage renal failure treated with recombinant interferon alpha. J Hepatol 1993;18(2):210-6.  Back to cited text no. 4    
5.Tohamy M, Abdul Naser M, Abdul Hafez Z, Abdullah M. Hepatitis C infection in hemodialysis patients and staff in Assiut renal dialysis units. Ain Sham Med J. 1992;43:625-34.  Back to cited text no. 5    
6.Medin C, Allander T, Roll M, Jacobson SH, Grillner L. Seroconversion to hepatitis C virus in dialysis patients: a retrospective and prospective study. Nephron 1993:65(l):40-5.  Back to cited text no. 6    
7.Hruby Z, Sliwinski J, Molin I, et al. High prevalence of antibodies to hepatitis C virus in three hemodialysis centres in South-Western Poland. Nephrol Dial Transplant 1993:8(8):740-3.  Back to cited text no. 7    
8.Fabrizi F, Raffaele L, Bacchini G, et al. Antibodies to hepatitis C virus (HCV) and transaminase concentration in chronic haemodialysis patients: a study with second-generation assays. Nephrol Dial Transplant 1993;8(8):744-7.  Back to cited text no. 8    
9.Dussol B, Chicheportiche C, Cantaloube JF, et al. Detection of hepatitis C infection by polymerase chain reaction among hemodialysis patients. Am J Kidney Dis 1993;22(4):574-80.  Back to cited text no. 9    
10.Tsianos EV, Dalekos GN, Elisaf M, Zervou E, Siamopoules KC. High frequency of antibodies to Hantaan virus and hepatitis C virus in chronic haemodialysis patients. Coincidence or cross reaction. J Intern Med 1993;234(6):607-10.  Back to cited text no. 10    
11.Ihara H, Kubo M, Miyamoto I, et al. Liver impairment in kidney transplant recipients. 1. Prevalence and clinical significance of hepatitis C. Nippon Jinzo Gakkai Shi 1993;35(10):1181-8.  Back to cited text no. 11    
12.Leblebicioglu H, Gunaydin M, Cengiz K, Islek I. Hepatitis markers in hemodialysis patients. Mikrobiyol Bui 1993;27(4):321-6.  Back to cited text no. 12    
13.Hayashi J, Nakashima K, Kajiyama W, et al. Prevalence of antibody to hepatitis C virus in hemodialysis patients. Am J Epidemiol 1991;134(6);651-7.  Back to cited text no. 13    
14.Esteban JI, Esteban R, Viladomiu VL, et al. Hepatitis C virus antibodies among risk groups in Spain. Lancet 1989;2:294-7.  Back to cited text no. 14    
15.Van der Poel CL, Reesink HW, Lelie PN, et al. Anti-hepatitis C antibodies and non-A, non-B post-transfusion hepatitis in the Netherlands. Lancet 1989;2:297-8.  Back to cited text no. 15  [PUBMED]  
16.Fakunle YM, Al-Mofarreh M, El­Karamany WM, et al. Prevalence of antibodies to hepatitis C virus in hemodialysis patients in Riyadh. Ann Saudi Med 1991;ll:504-6.  Back to cited text no. 16    
17.Picciotto A, Varagona G, Gurreri G, et al. Anti-hepatitis C virus antibodies and hepatiti* C virus viremia in haemodialysis patients. Nephrol Dial Transplant 1993;8(10):1115-7.  Back to cited text no. 17    
18.Silini E, Bono F, Cerino A, Piazza V, Solcia E, Mondelli MU, Virological features of hepatitis C virus infection in hemodialysis patients. J Clin Microbiol 1993;31(ll):2913-7.  Back to cited text no. 18    
19.P.ol S, Romeo R, Zins' B, et al. Hepatitis C virus RNA in anti-HCV positive hemodialyzed patients: significance and therapeutic implications. Kidney Int 1993;44(5):1097-100.  Back to cited text no. 19    
20.Jollif C. Classification and interpretation of Paragon serum protein electrophoresis patterns. Paragon 1991;1:13.  Back to cited text no. 20    
21.Sunderman FW Jr. Studies of the serum proteins VI. Advances in clinical interpretation of electrophoretic fractionations. Am J Clin Path. 1964;42:1.  Back to cited text no. 21    

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Correspondence Address:
Mohammad Amin Tashkandy
Department of Nephrology and Hypertension, Al Noor Specialist Hospital, Makkah Al Mukaramah
Saudi Arabia
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PMID: 18583858

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