|Year : 2017 | Volume
| Issue : 1 | Page : 102-106
|Hepatitis C in children with chronic kidney disease: A single-center, Egypt
Doaa Mohammed Youssef1, Hanaa Abdo1, Ahmed Alakhras1, Tamer Adham2, Abdelnasser Hussien Mohamoud3
1 Department of Pediatrics, Zagazig University, Zagazig, Egypt
2 Department of Pediatrics, Ain Shams University, Cairo, Egypt; Department of Pediatrics, University of Alberta, Alberta, Canada
3 Department of Pediatrics, Military Medical Academy, Cairo, Egypt
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|Date of Web Publication||12-Jan-2017|
| Abstract|| |
Prevalence of hepatitis C varies largely according to geographical distribution, and Egypt so far has the highest prevalence worldwide. The aim of this study was to evaluate hepatitis C infection in chronic kidney disease (CKD) children in our center with regard to its incidence and other morbidities. This is a cross-sectional study involving 50 children with CKD, not on dialysis. All patients underwent a thorough history taking including disease duration and mean duration of admission, clinical examination including blood pressure measurements, and routine laboratory examination such as hemoglobin level, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. The detection of anti-hepatitis C virus (HCV) antibodies was done in all patients based on the use of third-generation enzyme immunoassay (EIA) that detects antibodies directed against various HCV epitopes. Nine (18%) children were found to be hepatitis C positive and 41 were negative to hepatitis C. Infected cases were of older age group and had a longer duration of CKD, lower estimated glomerular filtration rate (eGFR), lower hemoglobin, higher ALT, higher serum urea, and creatinine. We conclude that 18% of children with CKDs have hepatitis C infection, and those with longer the duration of renal disease is more likely to be positive for HCV. Furthermore, HCV infection may predispose to higher deterioration of eGFR, lower hemoglobin level, and more days of admission. We recommend routine testing of HCV in all children with CKD.
|How to cite this article:|
Youssef DM, Abdo H, Alakhras A, Adham T, Mohamoud AH. Hepatitis C in children with chronic kidney disease: A single-center, Egypt. Saudi J Kidney Dis Transpl 2017;28:102-6
|How to cite this URL:|
Youssef DM, Abdo H, Alakhras A, Adham T, Mohamoud AH. Hepatitis C in children with chronic kidney disease: A single-center, Egypt. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2017 Nov 23];28:102-6. Available from: http://www.sjkdt.org/text.asp?2017/28/1/102/198161
| Introduction|| |
Hepatitis C virus (HCV) is a blood-borne pathogen that appears to be endemic in many parts of the world. There are, however, substantial geographic and temporal variations in the incidence and prevalence of HCV infection, largely due to differences in regional risk factors for the transmission of HCV. The highest prevalence of HCV has been found in Egypt (17-26%). ,
The prevalence of HCV infection is higher in most subgroups of chronic kidney disease (CKD) patients than in the general population. ,
Prevalence of pediatric HCV infection varies from 0.05-0.36% in the United States and Europe; up to 1.8-5.8% in some developing countries. The highest prevalence occurs in Egypt, Sub-Saharan Africa, Amazon Basin, and Mongolia. CKD patients should be tested for HCV as the first guideline of Kidney Disease Improving Global Outcome (KDIGO) 2008 (weak).
As there is very little known about HCV infection in infants and children with CKD, and this very limited information implies that the current guidelines do not apply directly and completely to this specific population, and as the KDIGO has recommended that pediatric nephrologists and other physicians - in charge of caring for children with CKD should carefully evaluate the extent to which the current guidelines may be extrapolated to children, we have tried to evaluate HCV infection in CKD children not yet on hemodialysis (HD) treated in our unit with regard to percentage of occurrence, relation to age, disease duration, and morbidity impact including effect on blood pressure, lower estimated glomerular filtration rate (eGFR), hemoglobin level, serum urea, and serum creatinine levels.
| Patients and Methods|| |
This was a cross-sectional study that included 50 children with CKD, not on dialysis, treated in Nephrology Unit, Zagazig University Children Hospital, during the period from April to October 2014.
Patients were divided into two groups; Group A with nine patients has CKD, not on dialysis with hepatitis C positive and Group B with 41 patients have CKD, they were not on dialysis with hepatitis C negative.
Our patients were 28 males and 22 females, aged 5-15 years. Etiologies of CKD were idiopathic nephrotic syndrome (72%, 36 patients), obstructive uropathy (22%, 11 patients), and cystic kidney diseases (6%, 3 patients). Their eGFR has ranged from 44-109 mL/min/1.73 m2 (i.e., CKD Stage 1-3).
All patients have undergone a thorough history taking including disease duration and mean duration of admission, clinical examination including blood pressure measurements, and routine laboratory examination as regard hemoglobin level, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine.
The detection of anti-HCV antibodies was done to all patients as it was based on the use of third-generation enzyme immunoassay (EIA) that detects antibodies directed against various HCV epitopes. EIA tests are reproducible, inexpensive, and suitable for use in the diagnosis of HCV infection. Given the good performance of third-generation EIA tests, immunoblot tests have become obsolete in clinical practice.
Informed consent was obtained, and the research was approved by the Ethical Committee of Zagazig University of Medical Sciences.
| Statistical Analysis|| |
The data were tabulated and statistically analyzed using Statistical Package for the Social Sciences (SPSS) software version 15.0 for Windows (SPSS Inc., Chicago, IL, USA). Data were expressed as a mean ± standard deviation for numerical variables. For all tests, P <0.05 was considered statistically significant.
| Results|| |
Demographic, clinical, and laboratory data of the studied groups
Our results have shown that hepatitis C infection is more prevalent among those with higher age, longer duration of CKD, and lower eGFR. It was also seen that hepatitis Cpositive cases have lower hemoglobin, higher ALT, and higher values of serum urea and creatinine ([Table 1]).
Correlation between serum ALT, serum AST and demographic, clinical, and laboratory data in Group A
Group A (HCV-positive cases) has had a high significant positive correlation with older age, disease duration, more number of admissions, and significant negative correlation with the level of eGFR, and no significant correlation with hemoglobin level or serum creatinine ([Table 2]).
|Table 2. Correlation between serum ALT, serum AST, and demographic and laboratory data in subgroup A.|
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| Discussion|| |
There are two types of tests for HCV. The simpler enzyme-linked immunosorbent assay (EIA) test looks for antibodies that the body produces to fight off the virus, whereas nucleic acid test (NAT) looks for the virus itself. NAT is more complicated and expensive, but it is more accurate, and it gives information about how infectious the patient is. The KDIGO guideline 2008 recommends that units where there are few or no HCV-infected patients should consider using the EIA test routinely and only test with NAT if the EIA test is positive.
Approximately, 3% of the world's population (roughly 170-200 million people) is infected with HCV. In Egypt, the situation is quite worse. Egypt has the highest prevalence of hepatitis C in the world. Among the population of 83 million in 2008, 14.7% was found to be infected with this virus. In Egypt, only a few studies are available regarding the exact number of children with CKD having HCV, despite the increase in the number of patients undergoing HD and the increase in the number of HCV prevalence. Therefore, the current study was aimed to establish a simple system to study the prevalence of HCV antibodies among children with CKD not yet on dialysis in Pediatric Nephrology Unit, Zagazig University Hospitals, and to study effects of HCV on increasing morbidities in those patients.
Our cross-sectional study was conducted over a period of six months from April to October 2014. A total of fifty patients were diagnosed with CKD. Among these patients, nine (18%) were found to be infected with HCV. The high percentage of HCV infection in our studied patients can be explained by the fact that CKD patients have a higher risk for acquiring HCV infections due to the frequent use of blood and blood products, and multiple invasive procedures performed in these patients, and also because Egypt has a high prevalence of HCV. , Our study has shown that HCV infection was higher among those in the higher age group as it was the most common in the age group of 13-17 years. The mean age of the HCVpositive patients was 11.8 years. This coincides with the results of Tsui et al and Moe et al who have stated that there that HCV infection was high among the higher age group but disagree with Noureddine et al who have stated that no significant difference according to age between HCV-positive and negative cases.
Our study has also shown that the prevalence of HCV was highly significant among those with longer duration of disease. The mean duration of disease for HCV-positive patients in our study was 6.21 years.
With respect to liver enzymes, a significant elevation of ALT (alanine transaminase) values was found among HCV-positive patients - in this study. This can be explained on the basis of the destruction of hepatocytes caused by the immune reaction of the body responding to the hepatitis viruses leading to excessive release of the transaminases. These findings were in accordance with the studies conducted in Karachi and Jenin district and Gaza strip in Palestine (Abumwais and Idris, 2010). This also agrees with Kosaraju et al and Noureddine et al. They stated that there was a statistically significant difference between the cases and controls with respect to liver function tests.
With respect to renal function tests, there were significantly high levels of urea and creatinine in HCV-positive patients. This was not in agreement with Kosaraju et al, as no statistically significant difference was observed between HCV-positive and negative patients with respect to serum levels of urea and creatinine. There were significantly lower levels of estimated GFR in HCV-positive patients in comparison with HCV-negative patients; in agreement with our results, Noureddine et al who found that there were significantly lower levels of estimated GFR in HCV-positive patients in comparison with HCV-negative patients.
There were significant higher levels of systolic blood pressure (SBP) and diastolic blood pressure in HCV-positive patients (in spite of antihypertensive drugs) versus HCV-negative patients. However, we should put in consideration that hypertension has multifactorial causes. This coincides with Moe et al who reported hypertension was more common with HCV positive in 1999 (50.8%) versus 4274 (46.5%) in HCV negative (P <0.001). However, Noureddine et al found that there was no significant difference in levels of SBP between HCV positive (144 ± 28) and HCV negative (145 ± 23).
| Conclusion|| |
We have concluded that 18% of children with CKD have hepatitis C infection and that the longer the duration of renal disease the more likely to be positive to HCV. We have also concluded that HCV infection may predispose to faster deterioration of eGFR, lower hemoglobin level, and a higher number of days needing admission.
We recommend routine testing of HCV in CKD children probably by EIA. This group of patients requires closer monitoring of their blood pressure, hemoglobin levels, and renal functions to help early detection of the potential complications. Nevertheless, all efforts should be done trying to prevent the transmission of HCV to patients.
| Limitations of the study|| |
Limitations of this study were that it is a cross-sectional, not a prospective one, and the number of patients involved is to some extent small.
Conflict of interest: None declared.
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Doaa Mohammed Youssef
Department of Pediatrics, Zagazig University, Zagazig, Egypt
[Table 1], [Table 2]
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