Hepatitis C is an important cause of renal disease, and renal complications
may be the presenting manifestation of hepatitis C infection. About half o
f patients present with evidence of renal insufficiency, and up to one quar
ter present with nephrotic syndrome. Others present with proteinuria or evi
dence of diminished renal function. The pathogenesis of hepatitis C-associa
ted renal disease remains incompletely defined, but most evidence suggests
that glomerular injury results from deposition of circulating immune comple
xes in the subendothelium and mesangium. Membranoproliferative glomerulonep
hritis, with or without cryoglobulinemia, is the most common renal lesion.
Interferon alpha-2b is currently the treatment of choice. However, success
is limited, with many patients failing to respond or suffering relapse upon
discontinuation of therapy. Studies of newer treatment modalities, such as
longer courses of interferon or the use of ribavirin or immunosuppressive
agents, are underway. Hepatitis C-associated renal disease may progress to
end-stage renal failure requiring dialysis in about 10% of patients. (C) 19
99 by Excerpta Medica, Inc.