How is hepatitis C virus (HCV) associated with end-stage renal disease (ESRD)?

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

An estimated 3.2 million Americans are infected with hepatitis C virus (HCV), and without treatment the majority will develop chronic liver disease. HCV is also the most common cause of essential mixed cryoglobulinemia. Of patients with HCV, 50% have measurable cryoglobulins, although only one third of these patients are symptomatic.

The most common cutaneous manifestation of cryoglobulinemia is palpable purpura resulting from an immune complex–mediated leukocytoclastic vasculitis. Other cutaneous manifestations of HCV infection include porphyria cutanea tarda (PCT), [15] lichen planus, necrolytic acral erythema (NAE), and cutaneous changes associated with chronic pruritus. NAE is a rare cutaneous condition affecting predominately the hands and feet. Previously considered pathognomonic for HCV infection, NAE has since been found in other conditions. Curiously, zinc deficiency may also be present, although zinc replacement does not always result in improvement in NAE.

Untreated renal involvement occurs in approximately 50% of patients with HCV and may progress to ESRD in approximately 10%. [16] Renal disease, primarily membranoproliferative or membranous glomerulonephritis, results from glomerular damage from circulating immune complexes.


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