OVERVIEW
OVERVIEW
Hepatitis C virus infection-associated glomerulonephritis refers to glomerulonephritis, or HCV-associated nephritis, caused by hepatitis C virus (HCV) infection through an associated immune response, often accompanied by cryoglobulinemia.
Whether medical insurance
Yes
Department
Nephrology
Clinical symptoms
Proteinuria, hematuria, hypertension, nephrotic syndrome, renal insufficiency; may be accompanied by multi-system damage, such as skin purpura and joint pain.
Hazards
Untimely treatment may lead to aggravation of nephropathy and even renal failure.
Complications
Hypertension, skin purpura, joint pain, chronic renal failure.
Examination
Serum anti-HCV antibody and HCV-RNA test, urine examination, liver and kidney function test, serum immunology test, serum cryoglobulin test, renal histopathology.
Diagnosis
The diagnosis can be confirmed based on clinical symptoms such as hematuria and proteinuria, combined with a history of HCV, hypocomplementemia, positive serum cryoglobulin, and renal pathology.
Treatment principle
Antiviral and immunosuppressive therapy is the mainstay, supplemented by diuretic, antihypertensive, hepatoprotective and renal therapy.
Curability
About 1/3 can obtain complete or partial clinical remission, 1/3 can alternate between exacerbation and remission, and the other 1/3 has a chronic process.
Dietary recommendations
Low protein, low sodium diet.
Etiology
Etiology
The cause of the disease is not clear. It may be related to the deposition of HCV-related circulating immune complexes in the glomeruli, or the autoimmune reaction caused by the immune dysfunction of the body due to HCV infection, which leads to renal damage.
Symptoms and Diagnosis
Typical symptoms
Proteinuria, hematuria, and mild or moderate renal impairment. Mixed cryoglobulinemia symptoms, such as joint pain, skin purpura, and peripheral neuritis. Refractory hypertension manifesting as dizziness, headache, fatigue, palpitations, etc.
Other symptoms
Nephrotic syndrome or acute nephritic syndrome, such as edema.
Diagnostic basis
Clinical manifestations, hematuria, proteinuria, hypertension, joint pain, rash, etc. 2. Serological examination, anti-HCV (+), HCV-RNA (+), cryoglobulin (+), decreased complement C4, rheumatoid factor (+), etc. 3. Diagnosis of glomerulonephritis, exclusion of cryoglobulinemic nephritis secondary to other diseases. 4. Pathological examination of renal tissues in the presence of HCV infection on the basis of HCV antigen or HCV-RNA present.
Treatment
Treatment guidelines
Antiviral and immunosuppressive therapy is the mainstay, supplemented by diuretic, antihypertensive, hepatoprotective and renal therapy. If necessary, plasma exchange combined with immunosuppressive therapy is used to remove circulating cryoglobulins and prevent new antibody production.
Drug therapy
Interferon and ribavirin, which can reduce the symptoms of proteinuria, as well as promote the recovery of liver function, as well as promote the conversion of HCV blood. Thymopeptide a1, which has an immunomodulatory effect, may increase the probability of HCVRNA conversion. Patients with severe renal disease may be treated with glucocorticoids, immunosuppressants, and plasma exchange.
Prognosis
The 10-year survival rate for hepatitis C virus infection-associated glomerulonephritis is 80%; those with elevated creatinine at presentation have a poor prognosis. Most patients die of cardiovascular disease.
Nursing care
Daily care
Attention to more rest, self-monitoring of urine, appropriate exercise to enhance their immunity.
Dietary management
Low-salt, low-protein diet, choose high bioefficacy proteins, such as fish, eggs and milk. Reasonable combination of balanced nutrition, avoid stimulating food.