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Detection of Hepatitis C Viral Particles in Renal Tissue in Patients with HCV Associated Nephropathy: A Clinic Pathological Study

Mohamed Hussein Elmahdi*, Ahmed Mohammed Rashed, Alaa Saad Abd Elhamid

Introduction: Patients with Hepatitis C Virus (HCV) develop different types of renal injuries. Membranoproliferative Glomerulonephritis (MPGN) is the most common type occurs in HCV patients who are complicated with small- vessel vasculitis cryoglobulinaemia. The aim of this work is to study the detection of HCV-RNA in the renal tissue using both Polymerase Chain Reaction and In Situ Hybridization (PCR and ISH) Techniques. In addition, we investigate the different patterns of renal affection in association with HCV infection.

Methods: The material of this work consisted of 50 native renal biopsies taken from HCV seropositive patients with renal lesions. All cases were collected as paraffin-embedded blocks. All cases were examined using a light microscope and evaluated according to the type of renal tissue as well as assessment of the glomeruli, tubules, interstitium and Vessels. In Situ Hybridization (ISH) and Reverse Transcription Polymerase Chain Reaction (RT-PCR) were used for the detection of HCV RNA in renal biopsies.

Results: Our study sample showed male predominance which represented 86% of cases. The age range was 19-67 years with a mean age of 47.7 ± 8.8 years. Most cases showed glomerular diseases (46 cases representing 92%) and the most predominant glomerular disease was Membranoproliferative Glomerulonephritis (MPGN) (58%). There was a significant relation between the degree of tubular atrophy and interstitial fibrosis (p-value=0.036). Regarding vascular changes, most cases showed no vascular changes (62%). However, the predominant vascular lesion was vascular thickening (34%) with seven cases above 50 years old. Ten cases were found to have cryoglobulinaemia and the main associated clinical presentations were impaired renal functions (40%) and nephrotic syndrome. In this study detection of HCV-RNA in the included 50 renal biopsies was tested by using 2 techniques ISH and RT-PCR. Regarding the ISH technique, positive hybridization signals were detected in the tubular epithelium of 28 cases (56%). RT-PCR detected HCV-RNA in 40 cases (80%).

Conclusion: Renal affection represents a major entity of extra-hepatic affection in patients with HCV. Most of renal affection is in the form of MPGN, but other forms of affection may occur and progress to end-stage renal disease. In addition, renal affection is due to viral invasion of renal tissue as proved by the detection of HCV-RNA within the tissues. Moreover, RT-PCR was found to be more sensitive than ISH.