Abstract

ABREU, Rui et al. Type II mixed cryoglobulinaemia due to hepatitis C virus infection: The role of new direct-acting antivirals in a kidney transplant recipient. Port J Nephrol Hypert [online]. 2016, vol.30, n.4, pp.308-311. ISSN 0872-0169.

Hepatitis C virus (HCV) infection remains prevalent in chronic kidney disease (CKD) patients. In a posttransplant patient, it can increase the risk for several complications such as transplant glomerulopathy and cryoglobulinaemia. We describe a 69 year-old woman with chronic kidney failure secondary to autosomal dominant polycystic kidney disease (ADPKD) on haemodialysis since January 1989. She had HCV infection (genotype 1b) diagnosed within the dialysis period. Liver biopsy revealed signs of chronic hepatitis. Ten years later, she underwent a deceased donor kidney transplant. She maintained normal kidney allograft function and subnephrotic proteinuria. In July 2015, she was hospitalized with necrotic ulcers in both legs. Laboratory findings revealed type II cryoglobulinaemia and low complement levels. HCV viraemia was high. Cutaneous biopsy showed a leukocytoclastic vasculitis. It was decided to treat cryoglobulinaemia and HCV infection with new direct-acting antivirals agents (DAAs) sofosbuvir/ledipasvir during 12 weeks. Skin ulcers improved and HCV RNA was undetectable after 4 weeks of treatment. Patient showed good tolerance for drug regimen. Proteinuria increased to nephrotic range after DAAs initiation. Donor-specific antibodies class I and II were negative and a kidney allograft biopsy demonstrated features of focal segmental glomerulosclerosis. Exacerbation of proteinuria in our patient could be a possible adverse effect of DAAs therapy, rarely reported in other cases

Keywords : cryoglobulinaemia; direct-acting antiviral agents; HCV infection; kidney transplant recipient; sofosbuvir/Ledipasvir.

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