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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2019  |  Volume : 30  |  Issue : 1  |  Page : 239-249
Hepatitis C virus-induced glomerular disease and posterior reversible encephalopathy syndrome after liver transplant: Case report and literature review


1 Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milano, Italy
2 Division of Neuro-Radiology, Maggiore Hospital and IRCCS Foundation, Milano, Italy
3 Division of Liver Transplant Surgery, Maggiore Hospital and IRCCS Foundation, Milano, Italy
4 Division of Gastroenterology and Hepatology, Maggiore Hospital and IRCCS Foundation, Milano, Italy
5 Division of Nephrology, Maggiore Hospital and IRCCS Foundation; School of Medicine, University of Milano, Milano, Italy

Correspondence Address:
Fabrizio Fabrizi
Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano
Italy
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DOI: 10.4103/1319-2442.252918

PMID: 30804289

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Chronic hepatitis C virus (HCV) infection is associated with numerous extra-hepatic complications, including neurological and renal manifestations. We describe the case of a 67-year-old Caucasian man with HCV-associated cryoglobulinemic glomerulonephritis, cirrhosis, and hepatocellular carcinoma. The early posttransplant course was complicated by fibrosing cholestatic hepatitis due to recurrent HCV in the graft (HCV RNA up to 44,944,438 IU/mL). Proliferative glomerulonephritis (nephritic and nephrotic syndrome) with mixed cryoglobulinemia (purpura) was also recorded. Seventy-two days after surgery, the patient presented with seizures and arterial hypertension; brain magnetic resonance imaging indicated the diagnosis of posterior reversible encephalopathy syndrome (PRES). PRES responded well to medical treatment with complete resolution of neurological changes. Antiviral therapy (sofosbuvir and ribavirin, six months) gave a sustained viral response with the improvement of cryoglobulinemic symptoms (including glomerular disease). Repeat liver biopsy revealed the regression of cholestatic damage and perisinusoidal fibrosis. The current follow-up shows stable chronic renal failure (serum creatinine: 1.4 mg/dL) and mild nephritic syndrome. The impact of extrahepatic manifestations of HCV on patient outcomes is highlighted from novel observational studies reporting a relationship between HCV cure (as expressed by the sustained viral response) and a decrease in both liver-related and renal complications. Clinical trials evaluating the efficacy and tolerance of novel direct-acting antiviral agents for the management of HCV-associated glomerular diseases are underway.


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